7 points, 2 tables, take you to unlock the new guide of blood sugar monitoring!

*Only for medical professionals to read and refer to the updated points of the blood glucose monitoring guidelines, please check! Blood glucose monitoring is an important part of diabetes management
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In recent years, with the increasing number of clinical research results in the field of blood glucose monitoring at home and abroad, the Diabetes Society of the Chinese Medical Association has also organized relevant experts to review the "Guidelines for Clinical Application of Blood Glucose Monitoring in China (2015 Edition)" (below) based on new evidence-based medical evidence.
The “Guidelines for Clinical Application of Blood Glucose Monitoring in China (2021 Edition)” (hereinafter referred to as the 2021 Edition Guidelines) have been revised and updated
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Let's take a look.
Compared with the content of the 2015 version of the guide, what are the update points of the 2021 version of the guide worthy of our attention? Seven major update points, one table to complete Table 1 List of seven major update points[1] Note: Glycated hemoglobin (HbA1c), continuous glucose monitoring (CGM), scanning glucose monitoring (FGM), glucose time in target range (TIR)
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These data and changes deserve attention[1]▌ The accuracy and precision of blood glucose meters require capillary blood glucose monitoring, including self-monitoring of blood glucose (SMBG) and point-of-care testing (POCT) in the hospital, which is the most important part of blood glucose monitoring.
basic form
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Accuracy and precision are the basic requirements to ensure accurate clinical testing of blood glucose meters
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The 2021 version of the guidelines revised the requirements for blood glucose meters in the 2015 version of the guidelines: "accuracy" was changed to "accuracy" and "precision" was changed to "precision"
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Accuracy: The degree of agreement between the blood glucose meter's measurements and the laboratory blood glucose test results
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Precision: the degree of agreement between repeated measurements of the same sample
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The change in the 2021 version of the guidelines is to adopt the health industry standard "Guidelines for Clinical Operation and Quality Management of Portable Blood Glucose Meters" (WS/T 781-2021) [3] - the requirements for accuracy, issued by the National Health Commission of China in April 2021.
For: when the blood glucose concentration is less than 5.
5 mmol/L, at least 95% of the test results are within the range of ±0.
83 mmol/L; when the blood glucose concentration is ≥5.
5 mmol/L, at least 95% of the test results are within the range of ±15%.
inside
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The requirements for precision are: when the blood glucose concentration is less than 5.
5 mmol/L, the standard deviation is less than 0.
42 mmol/L; when the blood glucose concentration is greater than or equal to 5.
5 mmol/L, the coefficient of variation is less than 7.
5%
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▌ The frequency of capillary blood glucose monitoring in the 2021 version of the guidelines is consistent with the 2015 version of the guidelines in terms of time points for blood glucose monitoring, but there are differences in the selection of capillary blood glucose monitoring schemes and frequencies
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The 2021 version of the guideline only gives principled recommendations for the recommendation of blood glucose monitoring programs, and proposes to formulate monitoring programs according to the specific conditions of patients
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The general principle is that for patients with stable blood sugar control, the monitoring interval can be appropriately flexible
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However, for patients with large blood sugar fluctuations, insulin therapy, recent hypoglycemia, adjustment of drugs or doses, pregnant patients, and patients with various stressful situations, the frequency of monitoring needs to be increased as appropriate
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▌ HbA1c is included in the diagnostic criteria for diabetes The "China Guidelines for the Prevention and Treatment of Type 2 Diabetes (2020 Edition)" includes HbA1c in the diagnostic criteria for diabetes [4], and the 2021 version of the guidelines is also consistent with it.
It is also clearly stated that when HbA1c < 6.
5%, diabetes diagnosed by venous blood glucose testing cannot be ruled out [5]
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▌ Classification of HbA1c Influencing Factors The 2021 guideline divides the factors affecting HbA1c into two categories [6,7]: 1.
Factors unrelated to the detection method, mainly including factors that affect the production and lifespan of erythrocytes themselves, and factors that affect the glycosylation of hemoglobin.
2.
Factors related to the specificity and anti-interference of detection methods, mainly including the presence of glycosylated hemoglobin precursors, hemoglobinopathies, abnormal hemoglobin, and the use of related drugs
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However, there are also individual cases where the above two factors are combined
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Therefore, the 2021 version of the guidelines proposes that judgments should be made based on the specific clinical situation of patients
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▌ Added relevant content of scanning glucose monitoring.
The 2015 version of the guidelines divides CGM into retrospective CGM and real-time CGM
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The 2021 version of the guide divides CGM into three categories: retrospective CGM, real-time CGM, and scanning CGM, adding relevant content of the FGM system
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The FGM system can monitor continuously for 14 days without finger blood correction, which saves the pain of frequent blood collection and helps improve the compliance of patients with blood glucose monitoring [4]
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The use of FGM significantly improved the risk of hypoglycemia, TIR, blood glucose fluctuations, and user satisfaction in diabetic patients [8]
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▌ CGM Atlas Interpretation The 2015 guideline and the 2021 guideline both recommend the use of a "three-step method" to interpret the CGM spectrum
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The 2021 version of the guidelines suggests that the first step is to look at the risk of hypoglycemia, the second step is to look at hyperglycemia, and the third step is to look at blood sugar fluctuations (including intraday blood sugar fluctuations and daytime blood sugar fluctuation characteristics)
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The 2021 version of the guidelines recommends the use of the standardized reporting form of the AGP map [9], where the glucose data of multiple days are superimposed and merged into a 24-hour time dimension, and the percentile reflects the degree of intraday variation of glucose at a certain time point
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▌ Incorporating TIR into the blood glucose control target TIR refers to the time (expressed in minutes) or its percentage (expressed in %) within the target range (usually 3.
9-10.
0 mmol/L for non-pregnant adults) within 24 hours.

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The 2021 version of the guideline refers to the 2019 TIR international consensus [9], and lists the recommendations for TIR, hyperglycemia time, and hypoglycemia time in adults with non-pregnant type 1 diabetes, type 2 diabetes, and elderly and high-risk diabetic patients in a tabular form.
The control target value is recommended, and the TIR control target for most adults with non-pregnant type 1 diabetes and type 2 diabetes is >70%, and it is also emphasized that the individual target value should be set according to the specific situation of the patient
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Five major blood glucose monitoring methods are irreplaceable In addition, it is worth noting that, different from the 2015 version of the guideline, the 2021 version of the guideline introduces five commonly used clinical blood glucose monitoring methods in chapters, and lists the main points at the beginning of each chapter.
As a reminder, the level of evidence (divided into A, B, and C) is marked (Table 2) for reference by clinicians
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Table 2 Differences between the five major blood glucose monitoring methods Note: 1,5-anhydroglucitol (1,5-AG), glycated albumin (GA)
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References: [1] Mo Yifei, Bao Yuqian.
Interpretation of "Guidelines for Clinical Application of Blood Glucose Monitoring in China (2021 Edition)" [J].
Chinese Journal of Diabetes, 2021, 13(10): 926-929.
[2] Li Wei Wei.
Guidelines for Clinical Application of Blood Glucose Monitoring in China (2015 Edition) [J].
PLA Medical Journal, 2015, v.
27; No.
185(11):123.
[3] National Health Commission of the People's Republic of China.
WS/T 781 -2021 Guidelines for Clinical Operation and Quality Management of Portable Blood Glucose Meters [S].
Beijing: China Standard Press, 2021.
[4] Diabetes Society of Chinese Medical Association.
China Guidelines for the Prevention and Treatment of Type 2 Diabetes (2020 Edition) [J].
Chinese Diabetes Journal, 2021, 13(4):315-409.
[5]World Health Organization.
Use of glycated haemoglobin(HbA1c) in the diagnosis of diabetes mellitus.
Abbreviated report of a WHO consultation,2011[EB/OL].
(2013 -11-12).
[6] Gao Ran, Zhong Jian, Cheng Xinqi.
Diagnosis of diabetes mellitus by glycosylated hemoglobin: knowing the influencing factors, rationally optimizing the use [J].
Chinese Journal of Diabetes, 2021, 13(4): 304-308.
[7 ]MalkaniS,MordesJP.
Implications of using hemoglobin A1C for diagnosing diabetes mellitus[J].
Am J Med,2011,124(5):395-401.
[8]DanneT,NimriR,BatelinoT,et al.
International consensus on use of continuous glucose monitoring[J].
Diabetes Care,2017,40(12):1631-1640.
[9]BatelinoT,DanneT,BergenstalRM,et al.
Clinical targets for continuous glucose monitoring data interpretation:recommendations from the international consensus on time in range[J].
Diabetes Care,2019,42(8):1593-1603.