IN BRIEF
The accurate measurement of glucose is extremely important in the diagnosis of diabetes and pre-diabetes, where the laboratory values are crucial; in the management of diabetes, where glucose meter values are crucial; and in attainment of goals in diabetes, where hemoglobin A1c measurement is crucial. This article reviews pitfalls that may interfere with accuracy of glucose measurement in each of these three areas and how this inaccuracy may be evaluated and managed in the primary care setting. Three case presentations of disparity are discussed.
IN BRIEF
Considering there are potentially seven points within a 24-hour glucose profile (pre-meals, post-meals, and at bedtime), the question of which of these values to target is important to both patients and busy practitioners. Appropriate targeting of plasma glucose may lead to less expense and less unnecessary testing for patients and may help patients and practitioners achieve glucose goals more expeditiously. This article suggests that targeting fasting plasma glucose is more beneficial when hemoglobin A1c (A1C)results are very high, whereas targeting postprandial glucose is more effective when A1C results are lower.
An annual methodology evaluation such as the one in this study should become a standard of care to identify patients for remedial classes to correct the source of error. The goal must be to meet or exceed the American Diabetes Association standard of 15% total error in home glucose monitoring.
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