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Glycaemic control

Quality statement

People with diabetes agree with their healthcare professional a documented personalised HbA1c target, usually between 48 mmol/mol and 58 mmol/mol (6.5% and 7.5%), and receive an ongoing review of treatment to minimise hypoglycaemia.

Quality measure

Structure

Evidence of local arrangements to ensure that people with diabetes are able to agree with their healthcare professional a documented personalised HbA1c target, usually between 48 mmol/mol and 58 mmol/mol (6.5% and 7.5%), and receive an ongoing review of treatment to minimise hypoglycaemia.

Process

a) Proportion of people with diabetes with a measured HbA1c.

Numerator - the number of people in the denominator with a measured HbA1c.

Denominator - the number of people with diabetes.

b) Proportion of people with diabetes who have an agreed target for HbA1c including a recently documented HbA1c.

Numerator - the number of people in the denominator with an agreed target for HbA1c including a recently documented HbA1c.

Denominator - the number of people with diabetes.

c) Proportion of people with diabetes achieving their HbA1c target.

Numerator - the number of people in the denominator achieving their HbA1c target.

Denominator - the number of people with diabetes.

d) Proportion of people with diabetes who have received a review of treatment to minimise hypoglycaemia in the previous 12 months.

Numerator - the number of people in the denominator receiving a review of treatment to minimise hypoglycaemia in the previous 12 months.

Denominator - the number of people with diabetes.

Outcomes

a) Proportion of people with diabetes with a documented HbA1c between 48 mmol/mol and 58 mmol/mol (6.5% and 7.5%).

Numerator - the number of people in the denominator with a documented HbA1c between 48 mmol/mol and 58 mmol/mol (6.5% and 7.5%).

Denominator - the number of people with diabetes.

b) Reduction in complications associated with diabetes.

Description of what the quality statement means for each audience

Service providers ensure local arrangements are in place to allow people with diabetes to agree and document a target HbA1c with their healthcare professional and receive ongoing review of treatment to minimise hypoglycaemia.

Healthcare professionals ensure they agree and document a target HbA1c with people with diabetes and ensure ongoing review of treatment to minimise hypoglycaemia.

Commissioners ensure they commission diabetes services that allow people with diabetes to agree and document a target HbA1c with their healthcare professional and receive ongoing review of treatment to minimise hypoglycaemia.

People with diabetes agree a target for HbA1c (a measure of blood sugar over 2-3 months), usually between 48 mmol/mol and 58 mmol/mol (6.5% and 7.5%), with their healthcare professional, and have their treatment reviewed continuously to help avoid low blood sugar (hypoglycaemia).

Source clinical guideline references

NICE clinical guideline 87 recommendation 1.3.1. (key priority for implementation).

NICE clinical guideline 15 recommendation 1.9.2.4.

Data source

Structure

Local data collection. DiabetesE and The National Diabetes Audit collect data on HbA1c levels.

Process

a), b), (c) and (d) Local data collection. DiabetesE and The National Diabetes Audit collect data on HbA1c levels.

Outcome

a) DiabetesE and The National Diabetes Audit collect data on HbA1c levels. Quality and Outcomes Framework (QOF) indicator DM 26 The percentage of patients with diabetes in whom the last IFCC-HbA1c is 59 mmol/mol (equivalent to HbA1c of 7.5% in DCCT values) or less (or equivalent test/reference range depending on local laboratory) in the preceding 15 months.

b) Local data collection. Hospital Episode Statistics (HES) collects data on complications associated with diabetes and the English National Screening Programme for Diabetic Retinopathy collects data on incidence and severity of retinopathy in England.

Definitions

The way in which HbA1c results are reported has changed from a percentage (%) to measurement in millimoles per mol (mmol/mol). For further information and a conversion chart please see A change in reporting your HbA1c results. Information for people with diabetes.

Healthcare professionals should document clinical reasons why the usual target for HbA1c, usually between 48 mmol/mol and 58 mmol/mol (6.5% and 7.5%) is not appropriate.

Equality and diversity considerations

All information about treatment and care, including agreeing a target for HbA1c, should be tailored to the individual. It should be accessible to people with physical, sensory (for example, visual impairment) or learning disabilities, and to people who do not speak or read English. If needed, people with diabetes should have access to an interpreter or advocate. Healthcare professionals will also need to consider cultural and religious requirements in relation to self-management. For example, some religions include periods of fasting, and people with diabetes will need appropriate information about managing their blood glucose levels during these periods.

This page was last updated: 25 March 2011

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Selected, reliable information for health and social care in one place

Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.