| name | t2dm-hba1c-target-and-intensification |
| description | Guides individualised HbA1c target-setting and identifies the correct intensification trigger for adults with type 2 diabetes using the NICE NG28 (2026) framework, covering standard targets, hypoglycaemia-risk adjustment, indications for target relaxation, and appropriate monitoring frequency.
|
| source_guideline | Type 2 Diabetes in Adults: Management (NG28) |
| publishing_body | National Institute for Health and Care Excellence (NICE) |
| year | 2026 |
| url | https://www.nice.org.uk/guidance/ng28 |
| specialty | Endocrinology / General Practice |
| version | 1.0 |
Type 2 Diabetes — HbA1c Target-Setting and Intensification Triggers
Based on: Type 2 Diabetes in Adults: Management (NG28) — NICE (last updated February 2026)
Reference: https://www.nice.org.uk/guidance/ng28
PURPOSE
Use this skill at any structured diabetes review to answer three questions in sequence:
- What is the right HbA1c target for this individual?
- Is the current HbA1c result actionable — does it require intensification?
- How frequently should HbA1c be monitored going forward?
The skill applies the NICE NG28 Section 1.5 framework, which is built on the principle that
HbA1c targets must be individualised — agreed with the patient — rather than applied
universally.
STEP 1 — GATHER INFORMATION
Current glycaemic status
- Most recent HbA1c (mmol/mol), date of measurement, and method used (IFCC-calibrated?)
- Has an individualised HbA1c target previously been agreed with this patient?
- Frequency of recent HbA1c monitoring — is it in keeping with clinical need?
- Any unexplained discrepancy between HbA1c and self-monitored blood glucose readings
Current treatment
- Current glucose-lowering medicines: names, doses, duration
- Is the current regimen associated with hypoglycaemia risk? (Sulfonylureas and insulin are; metformin, SGLT-2 inhibitors, DPP-4 inhibitors, and GLP-1 receptor agonists generally are not)
- Recent adherence — has the person been taking medicines as prescribed?
- Recent diet and lifestyle changes
Factors relevant to target-setting
- Age and frailty status
- Hypoglycaemia awareness — is it intact or impaired?
- Risk of harm from hypoglycaemia: falls risk, driving or operating machinery, lives alone
- Comorbidities and life expectancy — is long-term risk reduction the primary goal?
- Quality of life impact of intensive management
- Patient preference and health literacy
Factors that invalidate HbA1c
- Conditions causing disturbed erythrocyte turnover: haemolytic anaemia, iron deficiency anaemia, haemoglobinopathy, recent blood transfusion, pregnancy
- If any are present, HbA1c is unreliable — alternative monitoring required (see Step 2)
STEP 2 — RULE IN / RULE OUT
Confirm HbA1c is a valid measure for this patient:
If any of the following apply, HbA1c monitoring is unreliable — do NOT use it to set or
assess targets. Use an alternative (see below):
