Metabolic control of DM2
It is necessary to know the degree of metabolic control in the type 2 diabetic patient in order to make the proper decisions for his/her treatment (Redsalud, 2006). It has been shown that there is a direct correlation between chronic hyperglycemia and damage to the patient's target systems and organs. The main tests for metabolic control are: glycosylated hemoglobin A1c (HbA1c) and glycemia.
HbA1c
It is currently the best control parameter of glycaemia and reports retrospectively, the glycemia average for a period of 6 to 12 weeks. Two important studies, UKPDS and DCCT, which demonstrated the relationship between metabolic control and appearance or aggravation of microangiopathic complications, employed it as an indicator of the degree of metabolic control. The goal of the treatment is to achieve HbA1c <7%, with individualized variations, the recommendation being that the HbA1c levels should be “the closest to normal, with the least risk of hypoglycemia for the patient”. The recommended frequency of check-ups is every 3 months. Considering the heterogeneity of the elderly, goals may be variable, with 7% in a patient in good conditions, to 8.0 - 8.5 % in a patient with limited life expectations due to comorbidities or with scarce awareness of hypoglycemias.
Glycemia
All patients should be checked with periodic laboratory glycemias or glycemias measured by capillary blood monitors in the clinic. In DM2 patients, this check-up should be carried out every three months. The goals or targets required for pre-prandial and postprandial glycemias appear in Table 3. Capillary glycemias assessed by the patient through self-monitoring are necessary only in DM2 patients on insulin treatment; the usefulness of selfmonitoring has not been demonstrated in DM2 patients with oral treatment.
