QUALITY-CONTROL OF INTENSIFIED INSULIN THERAPY - HBA(1) VERSUS BLOOD-GLUCOSE

Since the measurement of HbA(1) has become available to the diabetolog ists, the physicians and patients tend to rely exclusively on this par ameter for the assessment of metabolic control. Therefore, in this stu dy, 24 hour glucose profiles of 8 selected patients (4 under intensifi ed conventional therapy, ICT, and 4 under continuous subcutaneous insu lin infusion, CSII) with HbA(1) values indicating good metabolic contr ol were taken three times at four week intervals and were compared to mean blood glucose (MEG), mean average of glucose excursions (MAGE) an d Schlichtkrull's M-value. MBG of the 24 profiles was 114 +/- 21 mg/dl . The patients under CSII were somewhat lower than the patients under ICT. In 16 of the 24 profiles, there was at least one period of hypogl ycemia of 50 mg/dl and below Only in one patient, M-value and MAGE sho wed stable metabolic control. In conclusion, hyperglycemic excursions in patients under intensified conventional therapy or treated by conti nuous subcutaneous insulin infusion do escape their reflection in the HbA(1) values because of low blood sugar periods following hyperglycem ic swings. Undoubtedly, the partial failure of ICT and CSII to prevent diabetic complications might be ascribed to the incomplete assessment of the metabolic control based on HbA(1) values exclusively.