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Glycemic Control: Targets and Measurement

The holiday season is drawing to a close and we have a new year (2024) and an opportunity for a fresh start in front of us all. As the ball dropped at midnight, you’re still ... well, you — but if something about the countdown to a new year inspires you to embrace a clean slate, you’re certainly not alone. An estimated 44% of Americans set New Year’s resolutions to try to adopt self-betterment at the turn of the calendar year. Much of the resolutions are centered around weight loss and perhaps an overall healthier lifestyle. This focus of this blog will look at glycemic control and how diabetes patients and providers can manage one of the most common chronic diseases in this country.

Glycemic control remains a delicate balancing act. The diabetic patient is tasked with maintaining euglycemic (normal) blood glucose levels, a goal requiring education, decision strategies, volitional control, and the wisdom to avoid hyper- and hypoglycemia, with the latter defined as plasma glucose less than ∼60 mg/dl. Glucose levels must be controlled continuously and without holidays....pun intended. Failure to maintain euglycemia results from biological factors and psychosocial factors including overmedication and/or inappropriate choices regarding food, drink, and, in certain cases, exercise.

Physicians can provide surveillance over your blood glucose levels through a variety of pathways. Common blood tests include glycohemoglobin (A1c) and fructosamine. Both will be discussed at length below.

Glycohemoglobin (Hemoglobin A1c) - monitor for long-term glucose control

In red blood cells the amount of stable A1c increases with the average glucose concentration in the blood. This positive correlation makes these blood test a great way to measure glycosylated hemoglobin over the entire lifespan of a red blood cell (100-120 days) As a result this is measuring your average glucose levels over a 3-4 month period. Of note, glucose levels closer to the time of the blood draw will have greater influence on your A1c level. This risk of diabetic complications, such of diabetic nephropathy and retinopathy increases with poor metabolic control. Generally, your A1c level should remain less than 6.5%, ideally most clinicians want it less than 5.7%.

Fructosamine: monitor for short-term glucose control

Unlike the A1C test, the fructosamine test is not used as an initial screening test for people who do not have diabetes or who have well-controlled diabetes. Instead, the fructosamine test may be used in situations in which the A1C test is less reliable or doesn't offer the same information.

The fructosamine test may be more useful in certain situations, like managing diabetes in the short term, or with certain health conditions. For example, it may be used if you've had a recent change in your medicines or insulin, as it can help gauge the effectiveness of the new treatments in a more immediate time window.

The test may also be used during pregnancy when your body is changing constantly, which may lead to falsely low A1C results.

Health conditions in which the fructosamine test may offer benefits include:

Fructosamine may be a useful test for people who develop gestational diabetes (diabetes during pregnancy) because changes in red blood cells and rapid blood sugar increases can make A1C results less reliable.

Diabetes affects nearly every part of your body. However, diabetes and daily insulin injections doesn't have to become a life sentence. Alternations in diet and making physical activity part of your daily routine can really go a long way. Picking up patients with various diabetic emergencies is part of our common practice. Be aware of their immediate challenges and potential life threats.

Always remember - An ounce of prevention is worth a pound of cure.

January 1, 2024

Author: Joshua Ishmael, MBA, MLS(ASCP)CM, NRP

Pass with PASS, LLC.

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