Glycaemic targets for T2DM management and how to adjust them for different patie

Glycaemic targets for the management of type 2 diabetes mellitus

• The NICE guideline recommends that adults with type 2 diabetes aim for an HbA1c level of 48 mmol/mol (6.5%) if managed by lifestyle or lifestyle combined with a single drug not associated with hypoglycaemia, and 53 mmol/mol (7.0%) if on a drug associated with hypoglycaemia, supporting individualised targets based on patient circumstances.
• For adults whose diabetes is not adequately controlled by a single drug and HbA1c rises to 58 mmol/mol (7.5%) or higher, the target is supported to be 53 mmol/mol (7.0%), with support for intensified treatment.

Adjustment of targets for different patient populations

• Targets should be relaxed and individualized, especially for older or frailer patients, or those with significant comorbidities or reduced life expectancy, where tight control may pose high risks, including hypoglycaemia.
• In patients with a reduced risk of hypoglycaemia and longer life expectancy, more stringent targets (e.g., 48 mmol/mol (6.5%)) are appropriate, provided they can be achieved without adverse effects.
• For pregnant women or those planning pregnancy, specific targets are discussed in the NICE guideline on diabetes in pregnancy, emphasizing the importance of individualized care.