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.
- HbA1c estimates recent glycaemic exposure but hides variability and hypoglycaemia; pair it with capillary or CGM data when treatment decisions require patterns.
- Anaemia, haemoglobin variants, recent transfusion, pregnancy, advanced kidney disease and altered red-cell lifespan can make HbA1c misleading.
- Offer adults with type 1 diabetes a choice of real-time or intermittently scanned CGM, with education, alarm settings and an alternative capillary meter.
- Routine self-monitoring in non-insulin-treated type 2 diabetes is not universally helpful, but becomes appropriate for hypoglycaemia-risk medicines, pregnancy, acute illness, driving or structured treatment changes.
- Review fasting, post-meal, overnight and exercise patterns; avoid responding to every isolated reading with unplanned correction insulin.
- Driving rules, occupational risk and impaired hypoglycaemia awareness may require higher operational glucose thresholds than the long-term HbA1c target suggests.
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.
- Choose medicines and monitoring capable of reaching the goal safely, prioritising education and low-hypoglycaemia options when risk is high.
- Agree a review interval and explicit triggers for earlier reassessment, including severe hypoglycaemia, steroid treatment, pregnancy, acute illness or declining self-management capacity.
Key medicines
Fast-acting oral glucoseUse 15 to 20 g, recheck after 10 to 15 minutes, and repeat if still low.Use the individual's plan for children, pregnancy or pump systems. Chocolate and high-fat foods act slowly; follow recovery with longer-acting carbohydrate when the next meal is distant.
GlucagonAdminister the licensed rescue formulation by trained family, carer or clinician.Effect may be reduced after prolonged fasting, alcohol or depleted glycogen. Call emergency services, place safely, monitor recovery and investigate every event.