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How is my diabetes monitored?
Studies have shown that good control of diabetes not only improves immediate well-being but more importantly prolongs onset of complications of diabetes as kidney disease, stroke, heart attack, neuropathy and blindness.
Short-term measures include measurement of blood glucose, urea and creatinine and electrolytes as well as urine ketones and protein (microalbumin). However, measuring glucose alone is not good test for assessing effectiveness of your diabetic treatment and risk of you developing complications.
A protein called HbA1c measurement is the best test for monitor effectiveness of diabetes treatment. It shows how well your diabetes control has been over the last 3 months. If your HbA1c is >8%, your diabetes is poorly controlled and you are at risk of early death from complications such as kidney failure, heart attack and stroke. You need to talk to your doctor about further adjustments to your treatment regimen. If your clinic or doctor do not provide this test, you are being offered sub-standard care! At the time of writing, no doctor in PNG including the few diabetic clinics in PNG perform HbA1c testing!
Can HbA1c be used to make diagnosis of diabetes mellitus?
Yes. Recent evidences suggest use of HbA1c as an alternate if not better marker for diagnosis of diabetes. Since 2009, various organizations including WHO, International Expert Committee on HbA1c and American Diabetic Association have all released guidelines recommending the use of HbA1c in diagnosing diabetes mellitus. They recommend hbA1c cut-off level of >6.5% as an indication for diagnosis of diabetes and suggest that this should be confirmed by repeat testing on at least 2 occasions unless patient has sign and symptoms of diabetes or blood glucose also supports the diagnosis of diabetes. The advantage of measuring HbA1c is that fasting is not necessary and can be measured at any time of the day. It does not fluctuate as much as glucose and it represents an average blood glucose of patient over the last 2-3months. The main problem is that HbA1c measurement is expensive and is not widely available in most centres in PNG.