microalbuminuria. When measured directly, a microalbumin level of less than 30 mg per day is considered normal. A level between 30 and 299 mg per day is defined as microalbuminuria, and levels greater than 300 mg per day signify clinical albuminuria and incip- ient renal failure. Spot collections of urine to measure the micro- albumin to creatinine ratio are generally recommended. Patients with type 1 diabetes are screened annually after the 5th year of a diabetic diagnosis and during pregnancy, regardless of the dura- tion of diabetes. Patients with type 2 diabetes are screened at diagnosis for microalbuminuria and annually thereafter. Conclusion BGM, either with fingersticks and a glucometer or a continuous glucose monitor is an essential part of diabetes management plans. However, BGM alone does not improve diabetes out- comes. Patients must integrate results into their self-management plans to observe changes in blood glucose levels. A1C monitor- ing every 3 to 6 months for all persons with diabetes and a TIR for those using a CGM enables the health care provider to demon- strate to people how their self-monitoring at home correlates with References 1. Diabetes Control and Complications Trial Research Group. (1993). The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. New England Journal of Medicine, 329 (14), 977-986. 2. United Kingdom Prospective Diabetes Study (UKPDS) Group. (1988). Intensive blood- glucose control with sulfonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet, 352 , 836-853. 3. American Diabetes Association Professional Practice Committee. (2022). 6. Glycemic targets: Standards of medical care in diabetes, 2022. Diabetes Care, 45 (Suppl.1), S83-S96. https://doi.org/10.2337/dc22-S006 4. American Diabetes Association Professional Practice Committee. (2022). 7. Diabetes technology: Standards of medical care in diabetes, 2022. Diabetes Care, 45 (Suppl. 1), S97-S112. https://doi.org/10.2337/dc22-S007 5. Dickinson, J. K., Guzman, S. J., Maryniuk, M. D., O’Brian, C. A., Kadohiro, J. K., Jackson, R. A., D’Hondt, N., Montogomery, B, Close, K. L., & Funnell, M. M. (2017). The use of language in diabetes care and education. The Diabetes Educator, 43(6), 551-564. https:// doi:101177/0145721717735535 6. Powers, M. A., Bardsley, J.K., Cypress, M., Funnell, M.M., Harms, D., Hess-Fischl, A, Hooks, B., Isaacs, D., Mandel, E.D., Maryniuk, M.D., Norton, A., Rinker, J., Siminerio, L.M., and Uelman, S. (2020). Diabetes self-management education and support in adults with type 2 diabetes: A consensus report of the American Diabetes Association, the Association of Diabetes Care and Education Specialists, the Academy of Nutrition and Dietetics, the American Academy of Family Physicians, the American Academy of Pas, the American Association of Nurse Practitioners, and the American Pharmacists. The Diabetes Educator, 46(4), 350-369. https://journals.sagepub.com/doi/suppl/10.1177/0145721720930959 7. Austin, M. M., & Powers, M. A. (2017). Monitoring. In S. Cornell, C. Halstenson, & D. K. Miller (Eds.), The art and science of diabetes self- management education desk reference (4th, pp. 189-236). American Association of Diabetes Educators. 8. Garg, S.K. & Naik, R.G. (2009). Monitoring in diabetes. In H.E. Lebovitz (Ed.), Therapy for diabetes and related disorders (5th, pp.144– 160). Alexandria, VA: American Diabetes Association. 9. Kulkarni, K. (2006). Monitoring. In C. Mensing (Ed.), The art and science of diabetes self-management education: A desk reference for healthcare professionals (pp. 705–729). Chicago, IL: American Association of Diabetes Educators. 10. Olafsdottir, A. F., Polonsky, W., Bolinder, J., Hirsch, I. B., Dahlqvist, S., Wedel, H., Nystrom, T., Wijkman, M., Schwarcz, E., Hellman, J., Heise, T., & Lind, M. (2018). A randomized clinical trial of the effect of continuous glucose monitoring on nocturnal hypoglycemia, daytime hypoglycemia, glycemic variability, confidence in patients with type 1 diabetes treated with multiple daily insulin injections (GOLD-3). Diabetes Technology and Therapeutics, 20(4), 274-284. https://doi:10.1089/dia.2017.0363 11. Laffel, K. M., Kanapka, L. G., Beck, R. W., Bergamo, K., Clements, M. A., Criego, A., DeSalvo, D. J., Goland, R., Hood, K., Liljenquist, D., Messer, L. H., Monzavi, R., Mouse, T. J., Prahalad, P., Sherr, J., Simmons, J. H., Wadwa, R. P., Weinstock, R. S., Willi, S. M., & Miller, K. M. (2020). Effect of continuous glucose monitoring on glycemic control in adolescents and young adults with type 1 diabetes: A randomized clinical trial. JAMA, 323(23), 2388-2396. https://doi:10.1001/jama.2020.6940 12. Pratley, R. E., Kanapka, L.G., Rickets, M. R., Ahmann, A., Aleppo, G., Beck, R., Bhargava, A., Bode, B. W., Carlson, A., Chaytor, N. S., Fox, D. S., Goland, R., Hirsch, I. B., Kruger, D., Rationale: Continuous glucose monitoring (CGM) monitors glu- cose levels continuously, as often as every 5 minutes throughout the 24 hours of each day. BGM represents a blood glucose level at a given moment, indicating blood glucose levels at isolated times of the day. 2. The correct answer is D. Rationale: Blood glucose monitoring (BGM) provides information about how eating, physical activity, and medication-taking affect blood glucose levels. 3. The correct answer is C. Rationale: The American Diabetes Association (ADA) recom- mends 80 to 130 mg/dL for preprandial capillary blood glucose levels.
Self-Assessment Quiz Question #5 What is the primary purpose for treatment guidelines set in the management of diabetes for both type 1 and type 2? a. To ensure the blood glucose levels are maintained as close to optimal as possible. b. To prevent or delay potential complications caused by diabetes. c. To prevent diabetes from being passed from generation to generation. d. To educate the patient with diabetes on healthy living. the office monitoring of glucose management and is associated with the prevention of complications that occur with prolonged hyperglycemia. With advances in diabetes technology, CGM has moved beyond BGM by providing real-time data with an ability to detect glycemic trends, rate of change information, and gly- cemic variability in a range of time, all of which support efforts to minimize the complications associated with hypoglycemia and hyperglycemia. Kudva, Y. C., Levy, C., McGill, J. B., Peters, A., Philipson, L., Philis-Tsimikas, A., Pop-Busui, R., Shah, V. N., Thompson, M., Vendrame, F., Verdejo, A., Weinstock, R. S., Young, L., Miller, K. M. (2020). Effect of continuous glucose monitoring on hypoglycemia in older adults with type 1 diabetes: A randomized clinical trial. JAMA, 323(23), 2397-2406. https://doi:10.1001/ jama.2020.6928 13. Klonoff, D. C., Ahn, D., & Drincic, A. (2017). Continuous glucose monitoring: A review of the technology and clinical use. Diabetes Research and Clinical Practice, 133, 178-192. https:// doi.org/10.1016/j.diabres.2017.08.005 14. Klonoff, D. C. (2014). Point-of-care blood glucose meter accuracy in the hospital setting. Diabetes Spectrum, 27(3), 174-179. 15. Miller, E. M. (2020). Using continuous glucose monitoring in clinical practice. Clinical Diabetes, 38(5), 429-438. https://doi.org/10.2337/cd20-0043 16. Longo, R., & Sperling, S. (2019). Personal versus professional continuous glucose monitoring: When to use which on whom. Diabetes Spectrum, 32(3), 183-193. https://doi. org/10.2337/ds18-0093 17. Ziegler, R., Sengbusch, S., Kroger, J., Schubert, O., Werkmeister, P., Deiss, D., & Siegmund, T. (2019). Therapy adjustments based on trend arrows using continuous glucose monitoring systems. Journal of Diabetes Science and Technology, 13(4), 763-773. https:// doi:10.1177/1932296818822539 18. Czupryniak, L., Dzida, G., Fichna, P., Jarosz-Chobot, P., Gumprecht, J., Klupa, T., Mysliwiec, M., Szadkowska, A., Bomba-Opon, D., Czajkowski, K., Malecki, M. T., & Zozulinska- Ziolkiewicz, D. A. (2022). Ambulatory glucose profile (AGP) report in daily care of patients with diabetes: Practical tips and recommendations. Diabetes Therapy, 13(4), 811-821. https://doi.org/10.1007/s13300-022-01229-9 19. Martinez, M., Santamarina, J., Pavesi, A., Musso, C., Umpierrez, G.E. (2021). Glycemic variability and cardiovascular disease inpatients with type 2 diabetes. BMJ Open Diabetes Research Care, 9 http://doi.org/10.1136/bmjdrc-2020-002032 20. Ahn, D., Pettus, J., & Edelman, S. (2016). Unblinded CGM should replace blinded CGM in the clinical management of diabetes. Journal of Diabetes Science and Technology, 10(3), 793-798. https://doi:10.1177/1932296816632241 21. Cornell, S. (2017). Comparison of the diabetes guidelines from the ADA/EASD and the AACE/ACE. Journal of the American Pharmacists Association, 57, 261-265. http://dx.doi. org/10.1016/j.japh.2016.11.005 22. Schnell, O., Alawi, H., Battelino, T., Ceriello, A., Diem, P., Felton, A., Grzeszczak, W., Harno, K., Kempler, P., Satman, I., & Verges, B. (2011). Addressing schemes of self-monitoring of blood glucose in type 2 diabetes: A European perspective and expert recommendation. Diabetes Technology and Therapeutics, 13(9), 959-965. https://doi:10.1089/dia.2011.0028 23. Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) Research Group. (2015). Effect of intensive diabetes therapy on the progression of diabetes retinopathy in patients with type 1 diabetes: 18 years of follow- up in the DCCT/EDIC. Diabetes, 64(2), 631-642. https://doi:10.2337/db14-0903 24. American Diabetes Association. (2022). Standards of Medical Care in Diabetes—2022 Abridged for Primary Care Providers. Clinical Diabetes, 40(1), 10-38. https:// diabetesjournals.org/clinical/article/40/1/10/139035/Standards-of-Medical-Care-in- Diabetes-2022 4. The correct answer is C. Rationale: A1C levels can be converted to an estimated average glucose (eAG) using the following formula: 28.7 × A1C – 46.7 (28.7 × 9.2 – 46.7 = 217 mg/dL). 5. The correct answer is B. Rationale: The goals for the treatment of diabetes are intended to prevent or delay potential complications, which affect the pa- tient’s quality of life in addition to mortality. With that goal in mind, it is vital to understand that blood glucose levels only tell part of the story. Because diabetes is a leading risk factor for cardiovascular dis- ease, stroke, and renal failure, it is essential to monitor and con- trol the factors associated with these vascular complications. Blood pressure, lipid profile, and urine albumin levels should be measured as recommended by the American Diabetes Associa- tion to alert the clinician to potential complications related to diabetes.
MONITORING TECHNIQUES FOR OPTIMAL DIABETES MANAGEMENT AND CONTROL Self-Assessment Answers and Rationales 1. The correct answer is C.
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