A 78-year-old woman with type 2 diabetes presents to her physician for a biannual examination. She indicates that after having a new chef at home 3 months ago, she did not feel it necessary to check her blood glucose since the food is “so healthy” at the home. Which of the following methods of blood glucose monitoring, as a single measurement, would provide an overview of the average blood glucose level over the past several weeks?
Correct Answer: Fasting plasma glucose
Description: This question examines a common problem found in clinical practice. The gist of the problem is that patients often do not follow physician orders. With respect to the treatment of diabetes, an essential goal in diabetes management is the improvement of blood glucose control towards euglycemia throughout a patient's day. Improved levels of metabolic control have already been shown to decrease the morbidity associated with diabetes. The Diabetes Control and Complications Trial (DCCT), a landmark multicenter trial, demonstrated that any improvement in blood glucose control towards euglycemia is associated with both a delay in the onset and progression of existing long-term complications associated with diabetes. In the case of the DCCT, carefully controlled blood glucose levels can be obtained at all times of the day with the use of multiple insulin injections. This treatment approach mimicked how the pancreas varies the amount of insulin secreted at different times of the day in response to meals and during periods of fasting. Although the benefits of achieving and maintaining good blood glucose control are now clear, diabetes is a self-managed disease where many challenges still remain for patients seeking to improve the quality of their lives and reduce the risk of developing complications. Therefore, it is essential that for patients with diabetes, physicians and other healthcare providers learn how to properly perform and appropriately monitor daily blood glucose levels, so that informed decisions can be made on how to follow treatment regimens recommended by their healthcare team. The glycosylated hemoglobin (HbA1c) reflects the patient's mean blood glucose level over the past six to eight weeks. In non-diabetics, 4-6% of the total hemoglobin is HbA1c. A change of 1% can equal a 25-40 mg/dL change in the mean blood glucose. This test is often used as an adjunct to patient Home Blood Glucose Monitoring (HBGM). The fasting plasma glucose (FPG) is primarily used by hospitals. Whole blood concentrations are 15% lower than FPG. Home Blood Glucose Monitoring (HBGM) helps the patient achieve euglycemia throughout the day. It instantly accesses the effect of dietary intake, drugs, exercise and illness on blood glucose levels. Some of the disadvantages of this method are that it is invasive, expensive and technical. Urine glucose tests correlate poorly with blood glucose levels and represents blood glucose "hours ago". They are beneficial in patients who cannot perform invasive HBGM technique.
Category:
Pharmacology
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