Self-Assessment Quiz Question #6 When teaching a patient about the random plasma glucose test, it is important to explain that: a. The test should be performed first thing in the morning. b. The random plasma glucose test requires that the patient fast for 8 hours before the test. c. The test is performed when severe diabetic symptoms develop. d. Diabetes is diagnosed when the blood glucose is > 150 mg/dL. Management of diabetes mellitus focuses on glycemic control and prevention and reduction of complications. Successful management depends on a team approach that involves physicians, nurse practitioners, nurses, dieticians, pharmacists, and mental health professionals who have expertise in diabetes Glycemic control Glycemic control is assessed by the A1C measurement, continuous glucose monitoring (CGM), and self-monitoring of blood glucose (SMBG). Rationale for these tests includes (ADA, 2021e; 2021m): ● A1C reflects average glycemia over about a period of three months. This test is the primary test for the assessment of glycemic control and has strong predictive value for diabetic complications. ● CGM: CGM plays an important role in the assessment of the effectiveness and safety of treatment in many patients with type1 diabetes, including the prevention of hypoglycemia and in selected patients with type 2 diabetes. Self-monitoring blood glucose (SMBG) SMBG is essential to effective diabetes management. Individual patients’ needs and goals guide SMBG frequency and timing. Research findings have shown that in patients who have type 1 Continuous glucose monitoring (CGM) Most of the people who use CGM have type1 diabetes. Research is now underway to learn how CGM might help people who have type 2 diabetes. A healthcare provider’s prescription is needed to obtain CGM systems (NIDDK, 2021f). CGMs are approved for use by adults and children. Some models may be used for children as young as two years of age. CGM may be recommended if the patient (NIDDK, 2021f): ● Is on intensive insulin therapy (also referred to as tight blood sugar control) ● Has hypoglycemia unawareness (Hypoglycemia unawareness occurs when the patient does not feel or recognize the signs or symptoms of hypoglycemia; patients who have frequent episodes of hypoglycemia may no longer experience hypoglycemia’s usual warning symptoms). ● Often experiences episodes of elevated or low blood glucose CGM has evolved swiftly in terms of both accuracy and affordability. This means that many patients have data available to assist with both self-management and assessment by healthcare providers (ADA, 2021e). The ADA (2021e) makes the following recommendations for glucose assessment by continuous glucose monitoring. ● Standardized, single-page glucose reports from continuous glucose monitoring (CGM) devices with visual cues, such as the ambulatory glucose profile (AGP), should be considered as a standard printout for all CGM devices. ● Time in range (TIR) is associated with the risk of microvascular complications, should be an acceptable end point for clinical trials moving forward, and can be used for assessment of Insulin pumps Most people with type 1 diabetes should be treated with multiple daily injections of prandial insulin and basal insulin or continuous subcutaneous insulin infusion. Most people with type 1 diabetes
MANAGEMENT OF DIABETES MELLITUS
mellitus management. The most critical members of the team are patients and families who are ultimately responsible for adhering, or helping loved ones to adhere to, the treatment regimen (ADA, 2021l).
● SMBG: SMBG can be used with self-management and medication adjustment, especially in persons who are taking insulin. Recommendations for glycemic assessment are (ADA, 2021e): ● Assess glycemic status (A1C or other glycemic measurement) at least two times a year in patients who are meeting treatment goals (and who have stable glycemic control). ● Assess glycemic status at least quarterly, and as needed, in patients whose therapy has recently changed and/or who are not meeting glycemic goals.
diabetes, there is a correlation between greater SMBG frequency and lower A1C (American Diabetes Association, 2021e).
glycemic control. Additionally, time below target (,70 and ,54 mg/dL [3.9 and 3.0 mmol/L]) and time above target (.180 mg/dL [10.0 mmol/L]) are useful parameters for reevaluation of the treatment regimen. CGM systems use a tiny sensor that is inserted under the skin to check glucose levels in tissue fluid. The sensor remains in place for several days to a week and then is replaced. A transmitter relays information about glucose levels via radio waves from the sensor to a wireless monitor (NIDDK, 2021f). Advantages of a CGM system include (NIDDK, 2021f): ● An alarm can sound when glucose levels are too high or too low ● Meals, physical activity, and medicines can be noted in a CGM device, as well as glucose levels ● Data can be downloaded to a computer or smart device to improve visibility of glucose trends ● CGM systems offer better management of daily glucose levels ● There are fewer hypoglycemic emergencies with the use of a CGM ● With a CGM, fewer finger sticks are needed CGM has limitations, as well as advantages. These limitations include (NIDDK, 2021f): ● Most CGM models cannot be used to make treatment decisions unless the CGM reading is confirmed by doing a finger-stick glucose test. ● A CGM is more expensive than using a standard glucose meter. Patients should check their insurance plans or Medicare to see what costs are covered.
should use rapid-acting insulin analogs to reduce hypoglycemia risk (ADA 2021k).
Book Code: ANCCUS2423
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