Blood Glucose Testing Recommendations for Type 2 Diabetes
For patients with type 2 diabetes, measure HbA1c every 3 months until glycemic targets are achieved, then reduce frequency to every 6 months for those with stable control. 1
HbA1c Monitoring Frequency
Active Treatment Adjustment Phase
- Test HbA1c quarterly (every 3 months) when therapy has recently changed or when patients are not meeting glycemic goals 1
- This frequent monitoring allows timely treatment intensification and prevents prolonged periods of poor control 1
Stable Control Phase
- Test HbA1c every 6 months for patients meeting treatment goals with stable glycemic control 1
- For patients with exceptionally stable control over several years, annual testing may be acceptable 1
Special Circumstances
- Hospitalized patients with diabetes should have HbA1c measured if no result is available from the previous 3 months 1
- Point-of-care HbA1c testing provides opportunity for immediate treatment adjustments during clinic visits 1
Self-Monitoring of Blood Glucose (SMBG)
When SMBG is Essential
Patients should perform finger-stick blood glucose monitoring if they: 1
- Are taking insulin or medications with hypoglycemia risk (sulfonylureas) 1
- Are initiating or changing their diabetes treatment regimen 1
- Have not met treatment goals 1
- Have intercurrent illnesses 1
SMBG Frequency Considerations
- Patients on multiple daily insulin injections or insulin pump therapy: Test 3 or more times daily 1
- Patients on less intensive regimens (oral medications alone, basal insulin only): SMBG frequency should be individualized based on treatment complexity and glycemic stability 1
- For postprandial glucose targets, postprandial SMBG may be appropriate 1
Continuous Glucose Monitoring (CGM)
CGM is indicated for specific clinical situations: 1
- Unexplained severe or recurrent hypoglycemia 1
- Asymptomatic hypoglycemia or nocturnal hypoglycemia 1
- Hypoglycemia unawareness 1
- Large blood glucose excursions 1
- Refractory hyperglycemia, especially fasting 1
- In conjunction with intensive insulin regimens in adults (particularly age ≥25 years with type 1 diabetes, though evidence extends to type 2 diabetes on intensive insulin) 1
Glycemic Targets
Standard Target
Target HbA1c <7% (53 mmol/mol) for most nonpregnant adults with type 2 diabetes 1
- This target is based on landmark trials (DCCT, UKPDS) demonstrating reduced microvascular complications 1
- Fasting blood glucose target: 70-130 mg/dL 1
More Stringent Targets (HbA1c <6.5%)
Consider HbA1c <6.5% for patients with: 1
- Short duration of diabetes 1
- Long life expectancy 1
- No existing complications 1
- No significant cardiovascular disease 1
- Only if achievable without significant hypoglycemia or other adverse effects 1
Less Stringent Targets (HbA1c <8%)
Target HbA1c <8% for patients with: 1
- History of severe hypoglycemia 1
- Limited life expectancy 1
- Advanced microvascular or macrovascular complications 1
- Extensive comorbid conditions 1
- Long-standing diabetes difficult to control despite comprehensive treatment 1
- Frail older adults 1
- Age >65 years with significant comorbidities 1
Critical Implementation Points
Laboratory Requirements
- Only use NGSP-certified HbA1c methods traceable to the DCCT reference assay 1
- Point-of-care HbA1c devices should not be used for diagnosis, only for monitoring in CLIA-certified laboratories performing moderate complexity testing or higher 1
Common Pitfalls to Avoid
- Do not rely on HbA1c alone in patients with conditions affecting red blood cell turnover (anemia, hemoglobinopathies, recent blood transfusion) 1
- In such cases, consider glycated albumin (reflects 2-3 week average) or increase SMBG frequency 1
- Ensure patients receive proper SMBG training and routine follow-up evaluation of technique and data interpretation 1
Treatment Intensification Protocol
When HbA1c is above target, intensify therapy through: 1