Phillips Patrick J, Leow Stephen
MBBS, MA, FRACP, MRACMA, GradDipHealthEcon, is consultant endocrinologist, Queen Elizabeth Specialist Centre, Adelaide, South Australia.
Aust Fam Physician. 2014 Sep;43(9):611-5.
Safe adjustment of insulin therapy requires review of both long-term and short-term glycaemic control, HbA1c and blood glucose monitoring (BGM), respectively.
To summarise the information that HbA1c and BGM provide about glycaemic control and to outline how to use these measures to guide insulin therapy.
There are three components to the 24-hour blood glucose profile: 1. the flat baseline set by the fasting blood glucose 2. often a daytime increment in this baseline 3. the prandial blood glucose increase. Insulin therapy aims to sequentially control each component to achieve a desired level of glycaemic control (usually HbA1c <7%). Clinical use of the two glycaemic measures requires that BGM results are not highly variable (which complicates safe insulin adjustment) and that both BGM and HbA1c results are reliable. If these conditions are met and there is a discrepancy between the BGM profile and the average blood glucose expected from the measured HbA1c, there may be periods of undetected hyper- or hypoglycaemia over the 24-hour period, which require changes in insulin therapy.
安全调整胰岛素治疗需要分别回顾长期和短期血糖控制情况，即糖化血红蛋白（HbA1c）和血糖监测（BGM）。
总结HbA1c和BGM所提供的有关血糖控制的信息，并概述如何利用这些指标指导胰岛素治疗。
24小时血糖谱有三个组成部分：1. 空腹血糖设定的平稳基线；2. 该基线通常在白天有所升高；3. 餐后血糖升高。胰岛素治疗旨在依次控制每个组成部分，以达到理想的血糖控制水平（通常HbA1c<7%）。两种血糖指标的临床应用要求BGM结果变化不大（否则安全调整胰岛素会变得复杂），且BGM和HbA1c结果都可靠。如果满足这些条件，而BGM谱与根据测得的HbA1c预期的平均血糖之间存在差异，则在24小时内可能存在未被检测到的高血糖或低血糖时段，这就需要调整胰岛素治疗。
