Diabetes Health Guidelines

NICE set the diabetes health guidelines
NICE set the diabetes health guidelines

People with diabetes should work towards a number of different health targets.

The National Institute for Clinical Excellence (NICE) regularly sets and reviews health guidelines for people with diabetes, which the numbers below are based upon.

It’s useful to know these targets in preparation for your diabetes annual care review. To help record the results, you can download and print off free diabetes health results record sheet.

HbA1c targets

  • People with diabetes are generally advised to keep their HbA1c values below 48 mmol/mol (6.5%)

However, an individualised target should be set to take into account factors such as your daily activities, likelihood of developing complications and risks presented by hypoglycemia.

Ideally, the lower the HbA1c value you can achieve without increasing instances or severity of hypoglycemia, the better.

For comparison purposes, people without diabetes tend to get HbA1c readings in the 15 to 37 mmol/mol (3.5 to 5.5%) range.

Blood pressure (hypertension) guidelines

Blood pressure targets for type 1 diabetes:

  • Below 135/85 mmHg
  • Or below 130/80 mmHg if abnormal presence of albumin in the urine (a sign of diabetic kidney disease) or if there are signs of metabolic syndrome

Blood pressure targets for type 2 diabetes:

  • Below 140/80 mmHg
  • Or below 130/80 mmHg if you have kidney disease, retinopathy or have cerebrovascular disease (including stroke)

The target levels for people with diabetes with complications such as diabetic retinopathy and nephropathy (kidney disease) are lower than the target for people without diabetes because high blood pressure accelerates these conditions.

Blood fat (cholesterol) targets

The NICE guidelines do not list targets based solely on cholesterol levels for people with diabetes, however, cholesterol levels should be measured each year to assess risks of heart disease and other long term diabetes complications.
Patients for type 2 diabetes should have their risk for heart disease and stroke assessed by a risk assessment tool (QRISK2).

Charity Diabetes UK lists the following blood lipid (cholesterol) targets as a guide for people with diabetes:

  • Total cholesterol: under 4.0 mmol/l
  • LDL levels: below 2.0 mmol/l
  • HDL levels: at least 1.0 mmol/l (men) or 1.2 mmol/l (women)
  • Triglyceride levels: less than (or equal to) 1.7 mmol/l

Kidney guidelines

Kidney function guidelines for diabetic patients are as follows:

  • Albumin/creatinine ratio: less than or equal to 2.5 mg/mmol (men) or 3.5 mg/mmol (women)

It is less common for patients to be given the ratio and will generally be informed simply whether protein has been detected in the urine or not.

Body Mass Index (BMI) targets

People should aim to fall within the 'healthy' window of the following BMI ranges. BMI ranges also differ based on ethnicity.

  • Underweight: less than 18.5
  • Healthy: 18.5 to 24.9 (18.5 to 22.9 for Asians)
  • Overweight: 25 to 29.9 (23 to 24.9 for Asians)
  • Obese: 30 to 39.9 (25 to 34.9 for Asians)
  • Morbidly obese: equal to or greater than 40 (35 for Asians)

Note that some people, such as those with a large muscle mass to fat ratio, may be classified in a higher bracket. If in doubt or concerned, speak to your healthcare team.

  • Read more about BMI

Retinopathy exam

The ideal target is to be clear from any signs of retinal damage

People with diabetes should undergo a retinal screening examination once a year.

This will usually be carried out independently of your diabetes review.

If retinal damage is present, your healthcare team will advise as to whether treatment is needed.

Retinopathy takes a period of years to develop and can be treated so it’s important to be annually screened.

Foot examination

  • The target for a foot examination: is to have no signs of circulation or nerve damage and to be free from wounds, blisters, calluses, ingrown toenails, fungal infections or any signs of bone deformation.

A foot examination may or may not be included as part of your annual diabetes review. If it is not included in your diabetes review, you should be provided with a separate appointment.

If damage to foot is found, you may be referred to a podiatrist.

People with diabetes are particularly at risk of damage to the feet. It is important to regularly check your own feet therefore and contact your healthcare team if any damage to your feet is present. Do not be tempted to leave these problems until your next foot examination.

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