HbAlc

The best way to monitor long-term glycemic control and response to treatment is with HbAlc levels measured at 3-month intervals. If the first HbAlc indicates that glycemic control during the last 3 mondis was inadequate, the dosage may be increased for better control. 

Patients and clinicians can evaluate blood glucose control through a combination of self-monitoring of blood glucose data and hemoglobin HbAlc testing. 

Monotherapy with sulfonylureas generally produce a 1.5% to 2% decline in HbAlc concentrations and a 60 to 70 mg/dL (3.33-3.89 mmol/L) reduction in FBG levels. Secondary failure with these drugs occurs at a rate of 5% to 7% per year as a result of continued pancreatic p-cell destruction. One limitation of sulfonylurea therapy is the inability of these products to stimulate insulin release from (1-cells at extremely high glucose levels, a phenomenon called glucose toxicity. 

FPG levels by 30 to 50 mg/dL (1.67-2.78 mmol/L), and the overall effect on HbAlc is a 1% to 1.5% reduction. Onset of action for thiazolidinediones is delayed for several weeks and may require up to 12 weeks before maximum effects are observed. Combining a sulfonylurea, non-sulfonylurea secret-agogue, metformin, or insulin with a thiazolidinedione can improve HbAlc reductions to 2% to 2.5%. 

Several years have passed since you have been following MF s therapy. His weight is down to 230 lb (104.6 kg), and he tries to maintain his diet and exercise. His recent HbAlc levels have increased up to 8.4% from 7.2% despite combination therapy with sulfonylureas and metformin. The physician believes that it is time to start insulin therapy for MF and asks you to initiate therapy and follow his regimen. 

Reductions in HbAlc of 0.7%-0.8% were found in clinical trials verses placebo in both monotherapy and combination therapy using the recommended dose of sitagliptin 100 mg daily taken with or without food. Dosage adjustments to 50 mg and 25 mg daily are recommended for patients with moderate... 

Until HbAlc levels are at goal, quarterly visits with the patient s primary health care provider are recommended. Table 40-7 summarizes the specific ADA goals for therapy. The practitioner should review SMBG data and a current HbAlc level for progress and address any therapeutic or educational issues. 

Glucose tolerance testing Fasting blood glucose, HbAlc if... 

DEXA, dual-energy x-ray absorptiometry ECG, electrocardiogram GH, growth hormone HbAlc, glycosylated hemoglobin Alc. 

Measure blood glucose levels at baseline and every 3 months to assess for glucose intolerance and insulin resistance. Periodic measurement of glycosylated hemoglobin (HbAlc) also may be useful.34... 

HbAlc Glycosylated hemoglobin (hemoglobin Alc) ISH Isolated systolic hypertension... 

Answen D. HbAlc is glycosykted HbA and is produced slowly whenever the glucose in blood is elevated. It persists until the RfiC is destroyed and the Hb degraded and so is useful as a long-term indicator of glucose level... 

Class HbAlc reduction Name Dose range (mg/day) Comment... 

Alpha glucosidase inhibitors mainly reduced postprandial blood glucose and has a mean lowering of initial HbAlc of 0.5-1.0%. The major side effects are abdominal discomfort. Hence it is advised to begin with a low dose (25-50 mg) at the start of meals and increase slowly up to a dose of 100 mg three times daily, as judged by the patient s response. 

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