Monitoring

The National Institute for Health and Care Excellence (NICE) in the UK recommends a glycosylated haemoglobin (HbA1c) target level of 48 mmol/mol (6.5%) or lower.[37][35]

  • A less stringent target may be appropriate for some patient groups including very young children, older adults, people with a history of severe hypoglycaemia, and those with limited life expectancies, advanced microvascular or macrovascular complications, or comorbid conditions.[46]

  • If the patient is a child or young person, be aware that a stringent target can cause emotional distress and/or conflict with family members or carers and a compromise may need to be agreed.[35]

  • If the patient is an adult, agree an individualised HbA1c aim with them, taking into account factors such as the person's daily activities, aspirations, likelihood of complications, comorbidities, occupation, and history of hypoglycaemia.[37]

Measure HbA1c levels at least:

  • Every 3 months in children and young people aged under 18 years[35]

  • Every 3 to 6 months in adults.[35]

Monitor:

  • For thyroid disease at diagnosis and annually thereafter[35][37]

  • Eye health:

    • By advising children and young people under 18 years of age to have an eye examination by an optician every 2 years[35]

    • With structured eye screening annually in adults[37]

  • For diabetic retinopathy via annual screening from 12 years of age[35][37]

  • For moderately increased albuminuria (albumin:creatinine ratio [ACR] 3-30 mg/mmol; 'microalbuminuria') to detect diabetic kidney disease, annually from 12 years of age; use an early-morning urine sample for this.[35][37] Send the urine sample for estimation of ACR (estimating urine albumin concentration alone is a poor alternative) and measure eGFR at the same time.[37]

  • Blood pressure annually from 12 years of age[35][37]

  • Foot health of people at low risk of developing a diabetic foot problem annually[150]

    • Refer people who are at moderate or high risk of developing a diabetic foot problem to your local foot protection service[150]

    • See our topic Diabetic foot complications

  • Cardiovascular risk factors in adults annually, including estimated glomerular filtration rate (eGFR) and urine ACR, smoking, blood glucose control, blood pressure, full lipid profile, age, family history of cardiovascular disease, and abdominal adiposity[37]

  • For coeliac disease at diagnosis[151]

    • Advise people who have tested negative for coeliac disease that it may present with a wide range of symptoms and they should consult their healthcare professional if any of the symptoms of concern arise or persist.

Advise the patient to have regular dental examinations.[35]

Be alert to the possibility of bulimia nervosa, anorexia nervosa and disordered eating in patients with type 1 diabetes with:[37]

  • Over-concern with body shape and weight

  • Low BMI

  • Hypoglycaemia

  • Suboptimal overall blood glucose control.

Consider an early (or if needed, urgent) referral to local eating disorder services for patients with type 1 diabetes who have an eating disorder.[37]

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