Two tests better than one for diabetes control, Johns Hopkins expert tells doctors
Physicians and patients often too lax about monitoringIn a strongly worded review published in the recent edition of The Journal of the American Medical Association (JAMA), the head of the Johns Hopkins Diabetes Center urges physicians and patients to better use the blood-testing tools at hand to manage the disease and prevent most of its dire impact on the heart, kidneys, nerves and vision.
"The message is, we have tools that are very accurate, but they don't work at all if they are not used properly," says Christopher Saudek, M.D., a former president of the American Diabetes Association and lead author of the article. "If the goal of treatment is to prevent morbidity and mortality, we need to do a better job of monitoring our patients, as well as advising them."
Saudek and colleagues reviewed data from studies conducted between 1976 and 2005 and concluded that both self-monitoring of blood glucose (SMBG) and more precise physician testing of hemoglobin A1c (HbA1c) can help diabetics take proper control of their blood sugar levels and successfully manage their disease.
"Used together, self monitoring and A1c do work," says Saudek, along with "consistent communication between the patient and health care professional."
According to the ADA, an estimated 14.6 million people in the United States have been given a diagnosis of diabetes, most of them with so-called type 2 or adult onset. Their disease is marked by the body's inability to respond to insulin to break down glucose, or sugar.
Saudek said SMBG conducted by patients, according to their condition and type of diabetes, gives an accurate reflection of immediate blood glucose levels. HbA1c, however, performed in a doctor's office or clinic, is a better measure of long-term blood glucose control, which can be influenced by a number of physiological and behavioral factors. Saudek also recommends that diabetics should get their physician to conduct the HbA1c test every three to six months. The frequency of self-monitoring depends on the individual case, but can be anywhere from once daily to more than six times per day. If they are taking insulin, their treatment changes or their blood sugar stays too high, the self-monitoring should be done more frequently.
"The first step in preventing or delaying the onset of complications associated with diabetes is recognizing the risk factors, including uncontrolled blood glucose," added Saudek. "Assessing glycemia in diabetes can be a challenge, but approaches are available that promote successful management of blood glucose and may lead to a significant reduction in incidence and in medical treatment of diabetes."
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Last reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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