NICE guidance - HbA1c - General Practice Notebook

NICE guidance - HbA1c · reinforce advice about diet, lifestyle and adherence to drug treatment and · support the person to aim for an HbA1c level of 53mmol/mol ( ... NICEguidance-HbA1c-GeneralPracticeNotebook Gethelp GPnotebooknolongersupportsInternetExplorer.Toensurethesitefunctionsasintended,please upgradeyourbrowser.Microsoftisencouraginguserstoupgradetoitsmoremodern Edgebrowserforimprovedsecurityand functionality. Thissiteisintendedforhealthcareprofessionals Signin Register Selectyourcountryorregion UnitedKingdom UnitedStates Australia Ireland Round-upMCQs GEMs Aboutus TV Podcast StudyGroups Shortcuts Signin Register Selectyourcountryorregion UnitedKingdom UnitedStates Australia Ireland Round-upMCQs GEMs Aboutus TV Podcast StudyGroups Shortcuts NICEguidance-HbA1c FREEsubscriptionsfordoctorsandstudents...clickhereYouhave3moreopenaccesspages. AtargetHbA1cshouldbesetbetween6.5%(48mmol/mol)and7.5%(59mmol/mol), basedontheriskofmacrovascularandmicrovascularcomplications.Ingeneral, thelowertargetHbA1cispreferredforpeopleatsignificantriskofmacrovascular complications,buthighertargetsarenecessaryforthoseatriskofiatrogenic hypoglycaemia NICEnotethatfortype2diabetes(1): foradultswithtype2diabetesmanagedeitherbylifestyleanddiet, orbylifestyleanddietcombinedwithasingledrugnotassociatedwith hypoglycaemia,supportthepersontoaimforanHbA1clevelof48mmol/mol (6.5%) foradultsonadrugassociatedwithhypoglycaemia,supporttheperson toaimforanHbA1clevelof53mmol/mol(7.0%) inadultswithtype2diabetes,ifHbA1clevelsarenotadequatelycontrolled byasingledrugandriseto58mmol/mol(7.5%)orhigher: reinforceadviceaboutdiet,lifestyleandadherencetodrugtreatment and supportthepersontoaimforanHbA1clevelof53mmol/mol(7.0%) andintensifydrugtreatment considerrelaxingthetargetHbA1clevelonacase-by-casebasis,with particularconsiderationforpeoplewhoareolderorfrail,foradultswith type2diabetes: whoareunlikelytoachievelonger-termrisk-reductionbenefits,for example,peoplewithareducedlifeexpectancy forwhomtightbloodglucosecontrolposesahighriskoftheconsequences ofhypoglycaemia,forexample,peoplewhoareatriskoffalling,people whohaveimpairedawarenessofhypoglycaemia,andpeoplewhodriveor operatemachineryaspartoftheirjob forwhomintensivemanagementwouldnotbeappropriate,forexample, peoplewithsignificantcomorbidities Ifadultswithtype2diabetesachieveanHbA1clevelthatislowerthan theirtargetandtheyarenotexperiencinghypoglycaemia,encouragethemto maintainit.BeawarethatthereareotherpossiblereasonsforalowHbA1c level,forexample,deterioratingrenalfunctionorsuddenweightloss HbA1clowerthantarget: ifadultswithtype2diabetesachieveanHbA1clevelthatislower thantheirtargetandtheyarenotexperiencinghypoglycaemia,encourage themtomaintainit.Beawarethatthereareotherpossiblereasonsfor alowHbA1clevel,forexample,deterioratingrenalfunctionorsudden weightloss measuretheindividual'sHbA1clevelsat: 3-6-monthlyintervals(tailoredtoindividualneeds)untiltheblood glucoselevelisstableonunchangingtherapy 6-monthlyintervalsoncethebloodglucoselevelandbloodglucose-lowering therapyarestable NICEnotefortype1diabetes(2): supportadultswithtype1diabetestoaimforatargetHbA1clevel of48mmol/mol(6.5%)orlower,tominimisetheriskoflong-termvascular complications agreeanindividualisedHbA1ctargetwitheachadultwithtype1diabetes, takingintoaccountfactorssuchastheperson'sdailyactivities,aspirations, likelihoodofcomplications,comorbidities,occupationandhistoryofhypoglycaemia ensurethataimingforanHbA1ctargetisnotaccompaniedbyproblematic hypoglycaemiainadultswithtype1diabetes measureHbA1clevelsevery3-6monthsinadultswithtype1diabetes considermeasuringHbA1clevelsmoreofteninadultswithtype1diabetes iftheperson'sbloodglucosecontrolissuspectedtobechangingrapidly; forexample,iftheHbA1clevelhasrisenunexpectedlyaboveapreviously sustainedtarget Notes: IfHbA1cmonitoringisinvalidbecauseofdisturbederythrocyteturnover orabnormalhaemoglobintype,estimatetrendsinbloodglucosecontrolusing oneofthefollowing: fructosamineestimation quality-controlledbloodglucoseprofiles totalglycatedhaemoglobinestimation(ifabnormalhaemoglobins) Reference: (1)NICE(May2008).Type 2diabetesThemanagementoftype2diabetes (2)NICE(August2015). Type1diabetesinadults:diagnosisandmanagement Lastreviewed01/2018 Links: glycatedhemoglobin glucosecontrolandcardiovascularrisk bloodglucosemonitoringindiabetes Clinicalspecialties cardiovascularmedicine dermatology diabetesandendocrinology ear,noseandthroat evidence-basedmedicine gastroenterology generalinformation generalpractice geriatricmedicine gynaecology haematology immunology infectiousdisease MentalHealth musculoskeletalmedicine neurology nutrition obesity obstetrics oncology ophthalmology orthopaedics paediatrics palliativecare publichealth renalmedicine respiratoryandchestmedicine rheumatology surgery traumamedicine urology