3.4 Glycemic monitoring

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3.4.1 Self blood glucose testing (SMBG)

To be done frequently (preferably once /twice weekly covering pre-meal, post-meal) in persons who are on multiple dose insulin regimen or insulin pump, especially in T1DM and pregnancy. For others it is to be done as required according to clinical situations.

3.4.2 HbA1c

• Glycated hemoglobin is formed by non-enzymatic condensation of glucose with the globin component of hemoglobin. This generally reflects glycemic status over the preceding 2-3 months. The target of HbA1c is <7%. HbA1c guides change in the therapeutic regimen.
• HbA1c test should be done at least two times a year in those who are meeting treatment goals (and who have stable glycemic control) and quarterly in persons whose therapy has changed or who are not meeting glycemic goals.
• RBC turnover (blood loss, hemolysis, blood transfusion, pregnancy, etc.) and hemoglobin variants must be considered while testing HbA1c.
• Result may vary if not done from a standardized lab.

3.4.3 Continuous glucose monitoring (CGM)

Continuous glucose monitoring automatically monitors blood glucose throughout the day and night. A CGM works through a tiny sensor inserted in skin, usually on abdomen or arm. The sensor measures interstitial glucose level. It measures glucose every few minutes and gives real time update. While calculating the report of CGM the percentage of time a person’s blood sugar is found between 4.0-10.0 mmol/L is measured and this measured time is designated as Time in Range. The target of time in range to keep >70% (17hours).