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Primary Care GuidelinesAuthor: Juan Fernando Florido Santana
A podcast intended for healthcare professionals wanting to keep up to date relevant information about clinical practice guidelines Language: en-us Genres: Education, Health & Fitness, Medicine Contact email: Get it Feed URL: Get it iTunes ID: Get it |
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Podcast - NICE 2026 Type 2 Diabetes Guideline – Part 2: HbA1c Targets and Glucose Monitoring
Wednesday, 25 March, 2026
The video version of this podcast can be found here: · https://youtu.be/LsB8J96adC0This episode makes reference to guidelines produced by the "National Institute for Health and Care Excellence" in the UK, also referred to as "NICE". The content on this channel reflects my professional interpretation/summary of the guidance and I am in no way affiliated with, employed by or funded/sponsored by NICE.NICE stands for "National Institute for Health and Care Excellence" and is an independent organization within the UK healthcare system that produces evidence-based guidelines and recommendations to help healthcare professionals deliver the best possible care to patients, particularly within the NHS (National Health Service) by assessing new health technologies and treatments and determining their cost-effectiveness; essentially guiding best practices for patient care across the country.My name is Fernando Florido and I am a General Practitioner in the United Kingdom. In this episode I review the NICE guideline on Type 2 diabetes in adults: management, always focusing on what is relevant in Primary Care only.I am not giving medical advice; this video is intended for health care professionals, it is only my summary and my interpretation of the guidelines and you must use your clinical judgement. Disclaimer:The Video Content on this channel is for educational purposes and not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read or seen on this YouTube channel. The statements made throughout this video are not to be used or relied on to diagnose, treat, cure or prevent health conditions. In addition, transmission of this Content is not intended to create, and receipt by you does not constitute, a physician-patient relationship with Dr Fernando Florido, his employees, agents, independent contractors, or anyone acting on behalf of Dr Fernando Florido. Intro / outro music: Track: Halfway Through — Broke In Summer [Audio Library Release] Music provided by Audio Library Plus Watch: https://youtu.be/aBGk6aJM3IU Free Download / Stream: https://alplus.io/halfway-through There is a podcast version of this and other videos that you can access here: Primary Care guidelines podcast: · Redcircle: https://redcircle.com/shows/primary-care-guidelines· Spotify: https://open.spotify.com/show/5BmqS0Ol16oQ7Kr1WYzupK· Apple podcasts: https://podcasts.apple.com/gb/podcast/primary-care-guidelines/id1608821148 There is a YouTube version of this and other videos that you can access here: The Practical GP YouTube Channel: https://youtube.com/@practicalgp?si=ecJGF5QCuMLQ6hrk The NICE clinical guideline on Type 2 diabetes in adults: management [NG28] can be found here: · https://www.nice.org.uk/guidance/ng28 TranscriptIf you are listening to this podcast on YouTube, for a better experience, switch to the video version. The link is in the top right corner of the video and in the episode description.Hello and welcome, I’m Fernando, a GP in the UK. Today we are looking at the new updated NICE guideline on type 2 diabetes in adults, always focusing on what is relevant in Primary Care only. The diabetes guideline is a comprehensive document, so I am breaking it down into clear and practical sections.Today, we are focusing on blood glucose management, including HbA1c targets and glucose monitoring.In the last episode, we covered patient education, dietary advice, and bariatric surgery. In future episodes, we will move on to further drug treatment and the management of complications.Right, let’s jump into it.Let’s start with HbA1c measurement and targets.We should measure HbA1c every 3 to 6 months, tailored to the person, until levels are stable on unchanging therapy. Once HbA1c and treatment are stable, we should measure it every 6 months.If HbA1c is unreliable, for example because of abnormal haemoglobin or altered red cell turnover, we should use alternative methods. These include quality-controlled plasma glucose profiles, total glycated haemoglobin if abnormal haemoglobins are present, or fructosamine.If there is a mismatch between HbA1c and other glucose readings, we should investigate and seek specialist advice if needed.Now let’s talk about targets.We should agree an individual HbA1c target with each person. This should be a shared decision. We should encourage people to reach and maintain their target, unless doing so causes adverse effects, including hypoglycaemia, or reduces their quality of life.For people managed with lifestyle alone, or with medicines that do not cause hypoglycaemia, we should support them to aim for an HbA1c of 48 mmol per mol, or 6.5 percent.For people taking medicines associated with hypoglycaemia, we should support them to aim for 53 mmol per mol, or 7 percent.If HbA1c rises to 58 mmol per mol, or 7.5 percent or higher, we should reinforce advice about diet, lifestyle and adherence, and intensify treatment, aiming again for 53 mmol per mol or 7 per cent.We should consider relaxing HbA1c targets on a case-by-case basis. This is particularly important for older or frail adults, people with reduced life expectancy, those at high risk of hypoglycaemia, or those with significant comorbidities.If someone achieves an HbA1c lower than their agreed target and is not having hypoglycaemia, we should encourage them to maintain it. However, we should remember that a low HbA1c may sometimes be a sign of other issues, such as weight loss or deteriorating kidney function.Now let’s move to self-monitoring of capillary blood glucose.We should not routinely offer self-monitoring to everyone with type 2 diabetes.We should offer it if the person is on insulin, has hypoglycaemic episodes, is taking medicines that increase the risk of hypoglycaemia while driving or operating machinery, or is pregnant or planning pregnancy.Additionally, we should consider short term self-monitoring when starting corticosteroids, or to confirm suspected hypoglycaemia.During acute illness, we should review treatment because blood glucose levels can worsen.If someone is self-monitoring, we should carry out a structured review at least once a year. This should include checking their technique, how often they test, whether they understand the results, the impact on their quality of life, whether it is still beneficial, and the equipment they are using.Now let’s look at continuous glucose monitoring.NICE says that we should offer intermittently scanned continuous glucose monitoring, often called flash monitoring, to adults on multiple daily insulin injections if they have recurrent or severe hypoglycaemia, impaired hypoglycaemia awareness, a disability that prevents finger prick testing, or if they would otherwise need to test at least eight times a day.We should also offer flash monitoring to adults on insulin who would otherwise need help from a care worker or healthcare professional to monitor their glucose.We should consider real time continuous glucose monitoring instead of flash if it is available at the same or lower cost.Continuous glucose monitoring should be provided by a team with expertise, and it must be part of a wider self-management plan.People using continuous glucose monitoring still need to check capillary blood glucose at times. This is to confirm accuracy and as a back up if the device fails or glucose levels are changing quickly. They should be given enough test strips to do this safely.If someone cannot or does not want to use continuous monitoring, we should offer capillary blood glucose monitoring instead.We should review the use of continuous monitoring regularly as part of the diabetes care plan. If there are concerns about how it is being used, we should explore any problems and offer further education or support.Finally, a word on hyperglycaemia.If an adult with type 2 diabetes develops symptoms of hyperglycaemia, we should consider insulin or a sulfonylurea, and then review treatment once blood glucose returns to target.So that is it, a review of the first section of the NICE guideline on type 2 diabetes.We have come to the end of this episode. Remember that this is not medical advice but only my summary and my interpretation of the guidelines. You must always use your clinical judgement.Thank you for listening and goodbye.
