HbA1c Targets According to NICE Clinical Knowledge Summaries
According to NICE guidelines, the target HbA1c levels for adults with type 2 diabetes are 48 mmol/mol (6.5%) for those managed by lifestyle and diet or with a single drug not associated with hypoglycaemia, and 53 mmol/mol (7.0%) for adults on medications associated with hypoglycaemia. 1
Specific HbA1c Targets Based on Treatment Approach
- For adults with type 2 diabetes managed by lifestyle and diet alone, or by lifestyle and diet combined with a single drug not associated with hypoglycaemia, the target HbA1c level is 48 mmol/mol (6.5%) 1
- For adults on medications associated with hypoglycaemia, the target HbA1c level is 53 mmol/mol (7.0%) 1
- When HbA1c levels rise to 58 mmol/mol (7.5%) or higher despite single drug therapy, the target remains at 53 mmol/mol (7.0%) with intensification of drug treatment 1
Individualising HbA1c Targets
NICE recommends considering relaxation of target HbA1c levels on a case-by-case basis, particularly for:
- Older or frail individuals 1
- People with reduced life expectancy who are unlikely to achieve longer-term risk-reduction benefits 1
- Those at high risk of hypoglycaemia consequences (e.g., people at risk of falling, with impaired awareness of hypoglycaemia, or who drive/operate machinery as part of their job) 1
- Patients for whom intensive management would be inappropriate due to significant comorbidities 1
Monitoring and Management Approach
- Involve adults with type 2 diabetes in decisions about their individual HbA1c target 1
- Encourage patients to achieve and maintain their target unless adverse effects (including hypoglycaemia) or efforts to achieve the target impair quality of life 1
- When HbA1c levels are not adequately controlled by a single drug and rise to 58 mmol/mol (7.5%) or higher:
- Reinforce advice about diet, lifestyle and medication adherence
- Support the person to aim for an HbA1c level of 53 mmol/mol (7.0%)
- Intensify drug treatment 1
Clinical Considerations and Pitfalls
- Targeting HbA1c levels below 7% may increase risk for adverse effects including death, weight gain, and hypoglycaemia in many patients 1, 2
- Regular monitoring of HbA1c is essential - at least twice yearly in patients meeting treatment goals with stable glycemic control, and quarterly in patients whose therapy has changed or who are not meeting glycemic goals 2
- The proportion of daily blood glucose readings within target range (4-10 mmol/L) is approximately 60% in patients achieving HbA1c <58 mmol/mol (7.5%), which may be a realistic target for people with diabetes 3
Evidence Quality and Consistency
- The NICE guideline provides a clear description of benefits and harms of tight glycemic control, with specific target levels based on treatment modality 1
- These recommendations are consistent with other guidelines such as SIGN, which recommends an HbA1c target of 7.0% (53 mmol/mol) to reduce risk of microvascular and macrovascular disease 1
- The approach of individualizing targets is consistent across multiple guidelines, though specific target recommendations may vary slightly 2, 4