New HbA1c targets for type 1 adults following updated NICE guidelines

The National Institute for Health and Care Excellence (NICE) have advised that adults with type 1 diabetes should aim for an HbA1c level of 48mmol/mol (6.5 per cent) or lower.
NICE published their updated national guidelines for diabetes on 26 August, which includes guidance for type 1 adults, children with type 1 and type 2 diabetes, and patients with diabetic foot problems.
Type 1 diabetes in adults
In their guidelines, NICE report that HbA1c scores are above target levels in most adults with type 1 diabetes. This could lead to diabetes-related complications, such as blindness, heart disease and kidney failure.
To achieve reductions in HbA1c, and results of 48 mmol/mol or lower, NICE have recommended:
All type 1 adults are offered a structured education course, such as DAFNE, which is of proven benefit;
All type 1 adults are offered multiple daily injection basal-bolus insulin
Children with diabetes
Children with either type 1 or type 2 diabetes have also been advised to aim for HbA1c levels near the normal range (around 48 mmol/mol), and keep near normal blood glucose readings.
Those with suspected type 1 diabetes should be referred to a specialist diabetes team within the same day so immediate diagnosis and care can be provided.
Education programs have been advocated by NICE: for type 2 children, these should include lifestyle advice, while for type 1 children, programs should provide information on continuous glucose monitoring and provide access to mental health professionals.
Diabetic foot problems
Patients with a limb-threatening or life-threatening diabetic foot problem should immediately be referred to hospital, according to NICE.
Otherwise, patients with diabetic foot problems should be referred to the multidisciplinary foot care service within one working day.
Sir Andrew Dillo, chief executive of NICE, believes these updated guidelines will enable more people across the United Kingdom to receive the best treatment and support.
“They recommend effective and cost effective care and advice to NHS organisations on such things as setting up specialist services to reduce risk of diabetes-related amputation. Implementing these recommendations will help prevent serious illnesses linked to diabetes,” said Dillon.