Paper
Measurements of Glucose Control
Published Mar 1, 1987 · F. Service, P. O'brien, R. Rizza
Diabetes Care
143
Citations
3
Influential Citations
Abstract
Among the definitions of the verb control, the following best suits our purposes: "to exercise restraining or directing influence over, to regulate or curb" (1). When used in the context of blood glucose, it implies the restraint of disordered glycemic behavior of diabetes by restoration of glucose behavior toward that of the fully controlled or regulated state, i.e., the nondiabetic condition. Although there may be disagreements about the fine points of what constitutes good or bad glucose control, there probably is agreement that perfect glucose control requires achievement of the levels and patterns of glycemia seen in nondiabetic individuals. As is the case in most biological systems, the assessment of glucose control requires objective measurements rather than reliance on subjective symptoms. Techniques for the assessment of glucose control were developed several decades ago to determine the effectiveness of newly developed modified insulin preparations (2-9). Many of these techniques relied on periodic blood glucose measurements and determinations of urine glucose excretion. Although most of these approaches are of historic interest only, the need to measure glucose control is even more pressing today. Assessments of new treatments that have the potential to achieve normoglycemia and the role of glycemia on the degenerative complications of diabetes depend on measurements of glucose control. There are several facets to consider in the measurement of glucose control. J) Glucose behavior may be measured directly by the determination of glucose concentrations in blood or indirectly by measurements of urine glucose or glycosylated proteins. Because of the varying half-lives of these parameters, they provide short-term (e.g., plasma glucose), intermediate-term (e.g., glycosylated albumin, fructosamine), or long-term (e.g., glycosylated hemoglobin) indications of glucose control. 2) Measurement of glucose behavior should not be limited to mean glycemia. Because glycemia is not static but responsive to various stimuli, the pattern of glycemic behavior may have physiologic and pathophysiologic implications. 3) An important component of glucose behavior is the frequency and severity of hypoglycemia. Quantification of hypoglycemia is difficult primarily because of the problems associated with ascertainment. 4) The approach to measuring glucose control differs between clinical and research purposes, because the former requires information to make treatment judgments, whereas the latter requires comprehensive assessment of glucose behavior. 5) Measurement of glucose control varies between inpatient and outpatient settings because of the differences in purposes, in access for frequent blood sampling, and in duration of assessment.
Highly CitedMeasurements of glucose control are crucial for evaluating new treatments and understanding the role of glycemia on diabetes degenerative complications.
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