HbAlC levels

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. 

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. 

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. 

Ahern JA, Boland EA, Doane R, Ahem JJ, Rose P, Vincent M, Tamborlane WV. Insulin pump therapy in pediatrics a therapeutic alternative to safely lower HbAlc levels across all age groups. Pediatr Diabetes 2002 3(l) 10-5. 

Fig. 9.6 (A) Hemoglobin A1 c (HbAlc) levels in the inhaled and subcutaneous (SC) insulin groups. (B) Mean change in fasting plasma glucose concentration in the inhaled and SC insulin groups. (Reproduced with permission from [60]).

The aim of treatment is for the patient to attain the target HbAlc level of 6.5%, but not below this, to reduce the risk of suffering with microvascular complications. All patients should be given structured education (such as diet and exercise) and self-monitor their plasma glucose to ensure that they attain their individually agreed target. All choices are based on patient acceptability and cost-effectiveness. The following steps are recommended if HbAlc is not maintained below 7.5% ... 

Good blood glucose control can prevent the development and slow the progression of diabetic nephropathy, as well as preventing the other complications of diabetes, even if kidney failure has developed. This cannot be achieved by insulin alone, but requires a good diet too. Ideally HbAlc levels (a measure of average blood sugar control over three months) should be less than 7%. 

This study was designed as a proof-of-con-cept Phase 11 study to determine the safety and efficacy of Orahn in place of glybur-ide (a sulfonylurea) or insulin secretagogues on a long-term basis (90 days or more) in subjects with type 2 diabetes. The primary hypothesis was that Oralin could be used safely in combination with metformin to help maintain or improve the eight-point glucose profiles and the baseUne HbAlc levels at 90 days or more after treatment. 

In most countries today, the recommendation is therefore to reduce HbAlc values to a level below 7.0% (normal range 4.4-6.4%). Several surveys, however, indicate HbAlc levels in most diabetic populations to be above 8-9%, and a clinical experience of valnes of 10% or higher is not unnsnal [3]. Therefore, new treatment modalities seem to be needed. In this review, we will discuss... 

The combination of three oral antidiabetics can be compared with our approach, but the small number of trials published has not been able to bring HbAlc levels below 7.8% [19]. In three other published studies. Metformin and a sulfonylurea (SU) preparation have been combined with NPH insulin with only a modest effect on HbAlc values (probably due to a modest improvement of peripheral insulin resistance). 

Many patients on monotherapy with either metformin or sulfonylureas do not reach HbAlc levels <6.5-7%. A further reduction of HbAlc of 0.5-1% can be achieved by add-on therapy with AGIs... 

FBG, sting insulin, or HbAlc levels o Whole-body insulin resistance/sensitivity o Blood lipids... 

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