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PATIENT CARE

and diabetes complications was found to be linear: each 1.0% (absolute) reduction in mean A1c was associated with
a 37% decline in the risk of microvascular complications, a 14% lower rate of myocardial infarction, and a 21% reduc-
tion in deaths from diabetes. 20
While relatively stringent glycemic control has been demonstrated to be beneficial, the potential benefits of inten-
sive therapy need to be weighed against the risks of inducing episodes of hypoglycemia. Personalized and higher
A1c targets may be indicated in older patients with type 2 diabetes who have had diabetes for a long time, have ex-
perienced previous episodes of severe hypoglycemia, and who have coexistent cardiovascular risk factors. The CDA
CPG provides the following recommended targets for glycemic control (Figure 1): 21

Figure 1: CDA CPG-recommended targets for glycemic control

Reprinted from the Canadian Journal of Diabetes, Vol 37, S. Ali Imran, Remi Rabasa-Lhoret, Stuart Ross, Targets for Glycemic Control, Pages S31-S4,
Figure 1: CDA CPG-recommended targets for glycemic control
April 1, 2013, with permission from Elsevier. http://www.sciencedirect.com/science/journal/14992671?sdc=1
MONITORING GLYCEMIC CONTROL
For most individuals, A1c provides a dependable estimate of the mean plasma glucose over the previous three to four
2.6 Monitoring glycemic control
months: 50% of the result is determined by the mean blood glucose level over the 30 days immediately preceding the
testing; 40% by levels from 30 to 90 days prior to the test; and the remaining 10% by blood glucose levels from the pre-
vious 90 to 120 days. A1c testing is often carried out quarterly if glycemic targets are not being met and therapy is being
For most individuals, A1c provides a dependable estimate of the mean plasma glucose
adjusted. When glycemic targets are consistently being met, A1c testing can be carried out less frequently.
over the previous three to four months: 50% of the result is determined by the mean blood
While A1c testing provides very useful average information, it is not an accurate indicator of fluctuating blood
glucose level over the 30 days immediately preceding the testing; 40% by levels from 30
glucose levels. Self-monitoring of blood glucose can provide additional information about episodes of hypoglyce-
to 90 days prior to the test; and the remaining 10% by blood glucose levels from the
mia and hyperglycemia, and more timely feedback on the short-term effects of diet, lifestyle and pharmacological
previous 90 to 120 days. A1c testing is often carried out quarterly if glycemic targets are
agents. With this additional information, patients can become empowered to make diet and lifestyle choices that
can reduce the likelihood of large fluctuations in blood sugar levels and subsequent disease complications.
not being met and therapy is being adjusted. When glycemic targets are consistently being
met, A1c testing can be carried out less frequently.
For persons with type 1 diabetes, daily self-monitoring is essential. Testing three or more times daily has been asso-
ciated with a significant reduction in A1c. The evidence supporting self-monitoring is less compelling for persons
22
While A1c testing provides very useful average information, it is not an accurate indicator
of fluctuating blood glucose levels. Self-monitoring of blood glucose can provide additional
information about episodes of hypoglycemia and hyperglycemia, and more timely
CANADIAN JOURNAL of OPTOMETRY | REVUE CANADIENNE D’OPTOMÉTRIE VOL. 79 SUPPLEMENT 2, 2017
feedback on the short-term effects of diet, lifestyle and pharmacological agents. With this 11
additional information, patients can become empowered to make diet and lifestyle choices

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