Evidence-base - International Diabetes Federation

Global Guideline for Type 2 Diabetes
44
Limited care
MO L 1 If HbA 1c measurement is not available, blood glucose
could be used for clinical monitoring measured either
at site-of-care or in the laboratory.
MO L 2 Site-of-care capillary blood glucose meters should
be quality controlled by certified quality assurance
schemes or by reference to laboratory methods.
MO L 3 Visually read glucose test strips have a role in
emergency and remote situations where maintenance
of functional meters is not possible.
Comprehensive care
MO C 1 The principles are as for Recommended care, but
continuous glucose monitoring is an additional option
in the assessment of glucose profiles in people
with consistent glucose control problems, or with
problems of HbA 1c estimation.
MO C 2 HbA 1c measurement would be available at each visit,
and provided in electronic or paper diary form to the
person with diabetes.
Rationale
Type 2 diabetes results in progression of hyperglycaemia with time, and causes
organ damage through controllable hyperglycaemia. Accordingly glycaemic
control needs to be monitored. Some of this will be performed by the person
with diabetes with glucose measurements (see Chapter 8: Self monitoring),
some by site-of-care tests and some by laboratory methods.
Evidence-base
Major national guidelines now address this area in detail [1-3] . There are
recommendations for patients with stable control or those requiring
adjustments to their treatment regimen. Laboratory guidelines and other
publications address available methods and their quality implementation [4-6] .
The central role for the HbA 1c assay largely derives from its position in the
reports of the major outcomes studies (the DCCT [7] , the UKPDS [8] , ACCORD [9] ,
ADVANCE [10] and VADT [11]) . HbA 1c provides the main method by which clinicians
can relate individual blood glucose control to risk of complication development
and its measurement is mandatory where affordable/available and appropriate
for a particular patient.
The laboratory and site-of-care HbA 1c assays are precise and are
now aligned to an international reference method [12] . This important
development has lead to changes in the reporting of HbA 1c . Consensus
statements from the various international, professional diabetes and clinical
chemistry organisations [13,14] have recommended reporting of IFCC units
(mmol HbA 1c per mol unglycated haemoglobin). A number of countries
continue to report DCCT aligned values (%), especially in this transition
period, to familiarise health care professionals with the new IFCC units.