Appendix B

Blood Glucose Testing

Diagnosis is based on plasma glucose levels obtained from a venous sample (74). Information on diagnostic criteria, relative merits of different screening tests, and an algorithm for evaluating people at risk can be found atndep.nih.gov/ddi/#HC. Blood glucose testing can be performed
using different methods for different purposes.

Screening refers to testing asymptomatic individuals at high risk for diabetes via venous sample (preferred) or a capillary sample to determine if follow-up diagnostic testing is indicated (75).

Blood glucose testing to monitor glycemic status by patients and health care providers is considered a cornerstone of diabetes care. Results of monitoring are used to assess the efficacy of therapy and guide adjustments in medical nutrition therapy (MNT), exercise, and medications to achieve the best possible glucose control (76).

Blood glucose testing by people with diabetes—self-monitoring of blood glucose (SMBG)—is recommended for all people with type 1 diabetes. For most such patients, SMBG three or more times a day is recommended. For people with type 2 diabetes, the frequency of testing should be sufficient to facilitate reaching glucose goals. The frequency of testing should be increased with therapy modification (77).

Because the accuracy of SMBG depends on both the instrument and the user, the technique should be evaluated by a health care provider initially and then periodically (78).

Requirements for Laboratory Testing

All health care providers who perform finger sticks or other laboratory testing must be registered with the Centers for Medicare & Medicaid Services (CMS) under the Clinical Laboratory Improvement Amendment (CLIA), which established quality standards to ensure the accuracy, reliability, and timeliness of patient test results regardless of where the test is performed. Three categories of tests and certification have been established, depending on the complexity of the test method. CLIA has established compliance regulations for each level of testing that require quality control and documentation procedures (79).

Certain states have established additional requirements for various sites or health care providers. For specific additional requirements, health care providers should contact their state agency (see www.cms.hhs.gov/clia’s regulations for bloodborne pathogens must also be documented and maintained.

May 2007

National Diabetes Education Program (NDEP)    http://ndep.nih.gov
NIDDK, National Institutes of Health, Bethesda, MD

A Joint Initiative of the National Institutes of Health and the
Centers for Disease Control and Prevention