Glycaemic management

This chapter begins by reminding the reader that managing diabetes is more than managing blood sugars; it is about minimising cardiovascular risk. The accepted measure of cardiovascular risk for diabetes is HbA_1c. A review of the ACCORD and ADVANCE trials provides evidence that patients should not be held to identical HbA_1c targets, but that HbA_1c should be individualised according to various clinical parameters. As HbA_1c is the result of blood sugar control, self-monitoring of blood sugars does play a role in diabetes management. Indeed, management decisions require a review of both HbA_1c and blood sugars as each contributes very different information. The HbA_1c tells us whether the person’s management regime needs to be changed; blood sugar checks tell us what needs to be changed. Following a review of the available technology for blood sugar checks (blood glucose meters, continuous blood glucose monitoring systems), instruction is provided on how to read and interpret blood sugars for management decision-making.With good diabetes management, blood sugars may normalise. The chapter concludes with a review of the three-tiered classification system for defining remission of diabetes along with the recommendations for ongoing cardiovascular risk screening in this population.