Assessment of Glycemic Status
How to Assess
A1C measurement- Continuous glucose monitoring (CGM) using appropriate metrics (e.g., time in range [TIR] and/or glucose management indicator [GMI])
When to Assess
Glucose Assessment via CGM: The Ambulatory Glucose Profile (AGP) Report
Correlation Between A1C and Estimated Average Glucose (eAG)
A calculator for converting A1C results into eAG, in either mg/dL or mmol/L, is available at professional.diabetes.org/eAG.
Data in parentheses are a 95% CI.
Adapted from Nathan DM, Kuenen J, Borg R, Zheng H, Schoenfeld D; A1c-Derived Average Glucose Study Group. Translating the A1C assay into estimated average glucose values. Diabetes Care 2008;31:1473–1478.
| A1C (%) | mg/dL | mmol/L |
| 5 | 97 (76–120) | 5.4 (4.2–6.7) |
| 6 | 126 (100–152) | 7.0 (5.5–8.5) |
| 7 | 154 (123–185) | 8.6 (6.8–10.3) |
| 8 | 183 (147–217) | 10.2 (8.1–12.1) |
| 9 | 212 (170–249) | 11.8 (9.4–13.9) |
| 10 | 240 (193–282) | 13.4 (10.7–15.7) |
| 11 | 269 (217–314) | 14.9 (12.0–17.5) |
| 12 | 298 (240–347) | 16.5 (13.3–19.3) |
| A1C (%) | mg/dL | mmol/L |
| 5 | 97 (76–120) | 5.4 (4.2–6.7) |
| 6 | 126 (100–152) | 7.0 (5.5–8.5) |
| 7 | 154 (123–185) | 8.6 (6.8–10.3) |
| 8 | 183 (147–217) | 10.2 (8.1–12.1) |
| 9 | 212 (170–249) | 11.8 (9.4–13.9) |
| 10 | 240 (193–282) | 13.4 (10.7–15.7) |
| 11 | 269 (217–314) | 14.9 (12.0–17.5) |
| 12 | 298 (240–347) | 16.5 (13.3–19.3) |
Setting and Modifying Glycemic Goals
Glycemic goals should be individualized and periodically reevaluated.
Approach to Individualization of Glycemic Targets
Person and disease factors used to determine optimal glycemic targets. Characteristics and predicaments toward the left justify more stringent efforts to lower A1C; those toward the right suggest less stringent efforts. A1C 7% = 53 mmol/mol.
Adapted with permission from Inzucchi SE, Bergenstal RM, Buse JB, et al. Management of hyperglycemia in type 2 diabetes, 2015: a patient-centered approach: update to a position statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care 2015;38:140–149.
Person and disease factors used to determine optimal glycemic targets. Characteristics and predicaments toward the left justify more stringent efforts to lower A1C; those toward the right suggest less stringent efforts. A1C 7% = 53 mmol/mol.
Adapted with permission from Inzucchi SE, Bergenstal RM, Buse JB, et al. Management of hyperglycemia in type 2 diabetes, 2015: a patient-centered approach: update to a position statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care 2015;38:140–149.
Hypoglycemia Assessment, Prevention, and Treatment
Hypoglycemia is categorized into three levels based on blood glucose concentrations and symptom severity. Level 1 is glucose <70 mg/dL (<3.9 mmol/L) but ≥54 mg/dL (≥3.0 mmol/L). Level 2 is glucose <54 mg/dL (<3.0 mmol/L). Level 3 is a severe event characterized by altered mental and/or physical status requiring assistance for treatment of hypoglycemia, irrespective of glucose level.
| Assessment and medication selection | |
|---|---|
| Review hypoglycemia history at every clinical encounter in all at-risk individuals. |
| Screen for impaired hypoglycemia awareness in all at-risk individuals. |
| Consider hypoglycemia risk when selecting diabetes medications and setting glycemic goals. |
| Assessment and medication selection | |
|---|---|
| Review hypoglycemia history at every clinical encounter in all at-risk individuals. |
| Screen for impaired hypoglycemia awareness in all at-risk individuals. |
| Consider hypoglycemia risk when selecting diabetes medications and setting glycemic goals. |
| Prevention and management of hypoglycemia | |
|---|---|
| Use CGM for individuals at high risk for hypoglycemia. |
| Glucose is the preferred treatment for hypoglycemia in conscious individuals with glucose levels <70 mg/dL (<39 mmol/L), although any form of fast-acting carbohydrate can be used. Re-test and re-treat, if needed, after 15 minutes. |
| Ensure that glucagon is prescribed for all those taking insulin and those at high risk for hypoglycemia, with education provided on its use and proper storage. |
| Offer structured education on hypoglycemia prevention and treatment to all individuals taking insulin and those at high risk for hypoglycemia. |
| Upon occurrence of one or more episodes of level 2 or level 3 hypoglycemia, promptly reevaluate the treatment plan, including considering whether to deintensify or switch medications. |
| Refer individuals with impaired hypoglycemia awareness to a trained health care professional for evidence-based interventions to help reestablish awareness of hypoglycemia symptoms. |
| Conduct ongoing assessments of cognitive function, ensuring extra caution and support for hypoglycemia if impaired or declining cognition is identified. |
| Prevention and management of hypoglycemia | |
|---|---|
| Use CGM for individuals at high risk for hypoglycemia. |
| Glucose is the preferred treatment for hypoglycemia in conscious individuals with glucose levels <70 mg/dL (<39 mmol/L), although any form of fast-acting carbohydrate can be used. Re-test and re-treat, if needed, after 15 minutes. |
| Ensure that glucagon is prescribed for all those taking insulin and those at high risk for hypoglycemia, with education provided on its use and proper storage. |
| Offer structured education on hypoglycemia prevention and treatment to all individuals taking insulin and those at high risk for hypoglycemia. |
| Upon occurrence of one or more episodes of level 2 or level 3 hypoglycemia, promptly reevaluate the treatment plan, including considering whether to deintensify or switch medications. |
| Refer individuals with impaired hypoglycemia awareness to a trained health care professional for evidence-based interventions to help reestablish awareness of hypoglycemia symptoms. |
| Conduct ongoing assessments of cognitive function, ensuring extra caution and support for hypoglycemia if impaired or declining cognition is identified. |
