Key priorities for implementation

The following recommendations have been identified as priorities for implementation. The full list of recommendations is in section 1.

Education and information

Blood glucose management

  • Support adults with type 1 diabetes to aim for a target HbA1c level of 48 mmol/mol (6.5%) or lower, to minimise the risk of long‑term vascular complications. [new 2015]

  • Agree an individualised HbA1c target with each adult with type 1 diabetes, taking into account factors such as the person's daily activities, aspirations, likelihood of complications, comorbidities, occupation and history of hypoglycaemia. [new 2015]

  • Support adults with type 1 diabetes to test at least 4 times a day, and up to 10 times a day if any of the following apply:

    • the desired target for blood glucose control, measured by HbA1c level (see recommendation 1.6.6), is not achieved

    • the frequency of hypoglycaemic episodes increases

    • there is a legal requirement to do so (such as before driving, in line with the Driver and Vehicle Licensing Agency [DVLA] At a glance guide to the current medical standards of fitness to drive)

    • during periods of illness

    • before, during and after sport

    • when planning pregnancy, during pregnancy and while breastfeeding (see the NICE guideline on diabetes in pregnancy)

    • if there is a need to know blood glucose levels more than 4 times a day for other reasons (for example, impaired awareness of hypoglycaemia, high‑risk activities). [new 2015]

  • Advise adults with type 1 diabetes to aim for:

    • a fasting plasma glucose level of 5–7 mmol/litre on waking and

    • a plasma glucose level of 4–7 mmol/litre before meals at other times of the day. [new 2015]

Insulin therapy

  • Offer multiple daily injection basal–bolus insulin regimens, rather than twice-daily mixed insulin regimens, as the insulin injection regimen of choice for all adults with type 1 diabetes.Provide the person with guidance on using multiple daily injection basal–bolus insulin regimens. [new 2015]

Awareness and management of hypoglycaemia

  • Assess awareness of hypoglycaemia in adults with type 1 diabetes at each annual review. [new 2015]

Care of adults with type 1 diabetes in hospital

  • Enable adults with type 1 diabetes who are hospital inpatients to self‑administer subcutaneous insulin if they are willing and able and it is safe to do so. [new 2015]

  • National Institute for Health and Care Excellence (NICE)