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Cited by 373Diabetes Management and ResearchDiabetes Management and EducationDiabetes Treatment and Management

Assessing Glycemia in Diabetes Using Self-monitoring Blood Glucose and Hemoglobin A 1c

Saudek, Christopher D., Derr, Rachel L., Kalyani, Rita R.·2006·JAMA
DOI 10.1001/jama.295.14.1688
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Abstract

CONTEXT: With the increasing prevalence of diabetes, successful management of blood glucose control is increasingly important. Current approaches to assessing glycemia include the use of self-monitoring of blood glucose (SMBG) and hemoglobin A1c (HbA1c). OBJECTIVES: To assess the evidence underlying the use of these 2 modalities, to evaluate confounders and sources of error in each test, to describe upcoming developments, and to reach evidence-based conclusions on their optimal use. DATA SOURCES, STUDY SELECTION, AND DATA EXTRACTION: Reports identified from MEDLINE searches (1976-2005) using relevant terms were selected for quality and relevance to the stated questions. Particular attention was paid to larger cohort studies, clinical trials, meta-analyses, and established recommendations. DATA SYNTHESIS: If used properly SMBG gives an acceptably accurate reflection of immediate plasma glucose levels. Study results vary, but in general, the evidence supports a positive effect of regular SMBG for improving glycemia, particularly in individuals treated with insulin. The best timing of SMBG and its frequency are controversial issues, but the clinical recommendation is for regular monitoring with frequency depending on the treatment and the instability of glycemia. In the relatively near term, SMBG could gradually be replaced by continuous glucose monitoring. HbA1c measures long-term glycemic control, reflecting a time-weighted mean over the previous 3 to 4 months. There are a number of physiologic and methodologic confounders that can affect HbA1c, but standardization of assays has been well established. The main value of HbA1c is its use as a predictor of diabetic complications and the proven effect of improved control of HbA1c on complication risk. A reasonable target value for HbA1c is less than 7%. A new method for measuring HbA1c may cause significant changes in the recommended levels, the numbers reported, and even the name of the test. CONCLUSION: Assessing glycemia in diabetes can be a challenge, but approaches are available that promote successful management of blood glucose and may thereby lead to a significant reduction in morbidity and mortality related to diabetes.

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  • Intensive glycemic control improves vascular outcomes in type 1 diabetes.

    “Of note, these data from Hvidore and SEARCH are post-DCCT in which it has been shown conclusively that intensive glycemic control improves vascular outcomes in T1D.”

    From Epidemiology of type 1 diabetes (2010) · cites this paper as [100]

  • The DCCT demonstrated that intensive glycemic control reduces the long-term vascular complications of hyperglycemia in type 1 diabetes.

    “The DCCT demonstrated that intensive glycemic control reduces the long-term vascular complications of hyperglycemia in T1D.”

    From Epidemiology of type 1 diabetes (2010) · cites this paper as [100]

  • The DCCT/EDIC study showed that intensive glycemic control over a mean of 6.5 years reduced cardiovascular disease complications by 57% after a mean of 17 years of follow-up.

    “That said, the DCCT/EDIC study has shown that intensive glycemic control over a mean of 6.5 years reduced CVD complications by 57% after a mean of 17 years of follow-up100.”

    From Epidemiology of type 1 diabetes (2010) · cites this paper as [100]

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Authors
Saudek, C. D., Derr, R. L., & Kalyani, R. R.
Affiliations
Johns Hopkins University (US)
Corresponding author
Saudek, Christopher D.
ORCID
Kalyani, Rita R.
Venue
JAMA
Publisher
American Medical Association (AMA)
Published
2006-04-12
Volume
295
Issue
14
Pages
1688
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
DOI
10.1001/jama.295.14.1688
OpenAlex
W2128247875
Cited by
373
References
111
Citations by year
2026: 7 · 2025: 7 · 2024: 11 · 2023: 12 · 2022: 7 · 2021: 17 · 2020: 15 · 2019: 14 · 2018: 12 · 2017: 16 · 2016: 22 · 2015: 16 · 2014: 19 · 2013: 14 · 2012: 24
FWCI
22.64
Type
journal article
Language
en
Open access
closed
Locations
  • JAMA (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
Keywords
glycemic control, diabetes mellitus, self-monitoring of blood glucose, HbA1c, blood glucose monitoring, insulin therapy, continuous glucose monitoring, diabetes complications, HbA1c targets
MeSH terms
Diabetes Mellitus, Glycated Hemoglobin, Humans, Hyperglycemia, Hypoglycemia, Blood Glucose Self-Monitoring

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