29th May 2025

Monitoring and Targets

HbA1c should be monitored closely in patients newly diagnosed with T2DM, approximately every 3-6 months until the level stabilises and then every 6 months thereafter. The HbA1c target depends on the treatment the patient is taking and whether they have a history of hypoglycaemia:

48 mmol/mol      🡪  Patients who control their blood sugars via lifestyle modifications with or without a single medication that does not cause hypoglycaemia. 

53 mmol/mol      🡪 Patients whose treatment regime includes a medication that can cause hypoglycaemic episodes 

53 mmol/mol      🡪  Patients already taking one medication but HbA1c has risen to 58 mmol/mol and therefore a second agent is being introduced. 

In patients trying to control their sugar levels using lifestyle modifications and a single medication only, an HbA1c of 58 mmol/mol should trigger the introduction of further medication. At each stage where a new medication is started, education should be reinforced, and lifestyle modifications emphasised. HbA1c targets may be loosened on an individual basis in certain situations. These include:

• Where there is a significant risk to their health associated with hypoglycaemic episodes, for example in frailty.  
• If the patient has a reduced life expectancy and is therefore unlikely to benefit from the long-term effects of controlling sugar levels.
• The patient has significant comorbidities, so tight control of sugars would not be beneficial. 

Self-monitoring of capillary blood glucose is not routinely recommended for T2DM patients unless they are taking insulin or an oral agent that may lead to hypoglycaemic episodes (e.g. sulfonylureas), have a history of hypoglycaemia or are pregnant or trying to conceive. Continuous glucose monitoring, either intermittent scanned (isCGM) or real time (rtCGM) should be considered in T2DM patients injecting insulin multiple times per day and either have a risk of hypoglycaemia or impaired hypoglycaemia awareness. They are also used in patients with impaired cognitive ability who need to but are unable to self-monitor capillary blood glucose. Patients on CGM should still measure their capillary blood glucose to check the accuracy of the CGM and in case of device failure, but this can be done less frequently.