data enables the person with diabetes to take a more active role in their diabetes management and care. Working with a certified diabetes care and education specialist to learn about BGM and glucose pattern management is critical at the time of diagnosis as well as whenever there is a change in medication or their condi- tion or when glycemic goals are not being met6. Evidence-Based Practice: Findings from the Diabetes Control and Complication Trial (DCCT), a prospective randomized con- trol trial (RCT) of intensive glycemic management versus standard glycemic management in patients with type 1 diabetes, showed definitively better glycemic control with a 50%-76% reduction in the development and progression of microvascular complications (e.g., retinopathy, neuropathy, and chronic kidney disease) in pa- tients. In addition, the Epidemiology of Diabetes Interventions and Complications (EDIC) study followed patients from the DCCT study two decades later and found persistent microvascular ben- efits despite loss of follow-up among some patients 23 . Hemoglobin A1C The hemoglobin A1C level indicates the overall level of glucose stability or control. Glucose in the plasma is attached to the he- moglobin molecule in red blood cells by a process called glyca- tion, thus giving rise to the terms glycated and glycosylated he- moglobin. The most common type of hemoglobin found in adults is hemoglobin A. With the average life span of the red blood cell being about 120 days, A1C levels reflect weighted mean glucose from the preceding 12 weeks, with the most recent glucose lev- els having a more significant impact. Blood glucose levels from the most recent 30 days have a more substantial effect on A1C than those from the first 60 days. The more significant the amount of glycation present, the higher the A1C. Conditions that cause rapid turnovers of red blood cells, such as traumatic blood loss, chronic kidney disease, sickle cell disease, recent blood transfu- sions, or erythropoietin therapy, can interfere with A1C test ac- curacy. People with diabetes have higher A1C levels compared to people without diabetes. There is a strong relationship between high A1C levels and the risk of developing diabetes-related com- plications, including cardiovascular disease, retinopathy, and neu- ropathy. Most laboratories in the U.S. report A1C levels per the National Glycohemoglobin Standardization Program (NGSP). Average val- ues are standardized to the Diabetes Control and Complications Trial (DCCT) Research Group results. In persons without diabetes, Estimated average glucose (EAG) levels Patients often have difficulty understanding the relationship be - tween blood glucose levels and their A1C levels. The estimated average glucose (eAG) level can be used to quantify A1C levels in more familiar terms that closely represent daily blood glucose readings. Introduced by the ADA in 2010, any A1C level can be converted to an eAG by using the formula eAG = 28.7 × A1C – 46.7. For example, if a patient has an A1C level of 8.2, the health care provider can use the eAG conversion formula and show the patient their average blood glucose level is 189 mg/dL. Table 5 provides the estimated AG levels for A1C test results. Self-Assessment Quiz Question #4 An A1C of 9.2% correlates with a mean plasma blood glucose of:
Self-Assessment Quiz Question #2 What is the overall benefit of blood glucose monitoring (BGM)? a. Keeping a record of blood glucose control for the health care provider. b. Determining how often a patient monitors their blood glucose. c. Decreasing the need for frequent laboratory tests. d. Monitoring the effectiveness of the diabetes treatment plan. Self-Assessment Quiz Question #3 For nonpregnant adults with diabetes and without limited life expectancy, the American Diabetes Association (ADA) recom- mends that glycemic target levels for preprandial fasting blood glucose levels should be:
a. 60 to 90 mg/dL. b. 70 to 100 mg/dL. c. 80 to 130 mg/dL. d. 110 to 140 mg/dL.
the average A1C value ranges between 4 and 6 percent. In 2010, A1C levels were used as one criterion for diabetes. The ADA rec- ommends monitoring A1C levels at least twice per year for well- managed diabetes and quarterly when patients are not achieving glycemic targets. A1C testing and daily blood glucose monitoring provide useful in- formation in the management of diabetes, but they are expressed in different ways. Daily blood glucose monitoring via a glucom- eter directly measures the amount of glucose in the blood at the time the sample is taken and is expressed as milligrams of glucose per deciliter of blood (e.g., 154 mg/dL). A1C also uses a blood sample, but it looks at the percentage of hemoglobin, a protein in red blood cells that has attached to glucose (e.g., 7.0 percent). Evidence-Based Practice: An appropriate A1C goal for non- pregnant adults without a limited life expectancy is <7.0% (53 mmol/mol) without significant hypoglycemia. Less stringent A1C goals (e.g., <8.0%; 64 mmol/mol) may be appropriate for older persons or those with limited life expectancy, or where the harms of treatment are greater than the benefits. Health care providers must work with patients and consider adjusting glycemic targets to ensure safety and limit adverse effects 3 . Table 5. Estimated Average Glucose (eAG) Levels A1C (%) mg/dL mmol/L 5 97 (76 to 120) 5.4 (4.2 to 6.7) 6 126 (100 to 152) 7.0 (5.5 to 8.5) 7 154 (123 to 185) 8.6 (6.8 to 10.3) 8 183 (147 to 217) 10.2 (8.1 to 12.1) 9 212 (170 to 249) 11.8 (9.4 to 13.9) 10 240 (193 to 282) 13.4 (10.7 to 15.7) 11 269 (217 to 314) 14.9 (12.0 to 17.5) 12 298 (240 to 347) 16.5 (13.3 to 19.3) Adapted from American Diabetes Association3.
a. 167 mg/dL. b. 195 mg/dL. c. 217 mg/dL. d. 257 mg/dL.
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