Synopsis
Set safe person-centred glycaemic goals, choose reliable monitoring, and interpret HbA1c and glucose patterns without creating avoidable hypoglycaemia or treatment burden.
- A target is a shared clinical decision, not a performance grade; balance microvascular benefit against hypoglycaemia, frailty, comorbidity, treatment burden and the person's priorities.
- For most adults with type 1 diabetes NICE supports HbA1c 48 mmol/mol or lower when achievable safely; technology and education should support, not coerce, that goal.
- For type 2 diabetes, NICE target choice depends partly on whether treatment can cause hypoglycaemia, and targets should be relaxed when harms outweigh likely long-term benefit.
Key red flags
Reduced awareness, nocturnal episodes, seizure, third-party assistance, fear-driven restriction or recurrent time below range requires urgent education, target and medicine review rather than congratulation for a low HbA1c.
Investigation priorities
Estimate longer-term glycaemic exposure and track complication risk.
Management branches
Diagnosis, annual review, pregnancy planning or a major health change.
- Clarify diabetes type, complication risk, life expectancy, frailty, cognition, hypoglycaemia history, occupation, driving, support, treatment burden and what outcomes matter to the person.
- Use the relevant NICE starting target, then document why it is retained or modified and which outcomes—HbA1c, symptoms, time below range or severe events—will define success.
Key medicines
Fast-acting oral glucoseUse 15 to 20 g, recheck after 10 to 15 minutes, and repeat if still low.
GlucagonAdminister the licensed rescue formulation by trained family, carer or clinician.