Diabetes: HbA1c 75 mmol/mol

  • NICE indicator
  • IND180
  • Published:
  • Last updated:
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Indicator

The percentage of patients with diabetes with moderate or severe frailty, on the register, in whom the last IFCC-HbA1c is 75 mmol/mol or less in the preceding 12 months.

Indicator type

General practice indicator suitable for use in the Quality and Outcomes Framework.

This document does not represent formal NICE guidance. For a full list of NICE indicators, see our menu of indicators

To find out how to use indicators and how we develop them, see our NICE indicator process guide

Rationale

Applying universal HbA1c target levels to all people with diabetes regardless of co-morbidities may inadvertently lead to both under-treatment and over-treatment (Kearney et al. 2017). People with diabetes and less complex care needs may be undertreated, whilst people with more complex care needs may be at risk of overtreatment. In addition, intensive glucose lowering treatment may be dangerous for older people with type 2 diabetes (Strain et al. 2018). This indicator allows for an individualized management approach that adjusts care according to an individual's frailty status. It aims to reduce complications and improve quality of life for people with moderate or severe frailty.

Source guidance

Type 1 diabetes in adults: diagnosis and management. NICE guideline NG17 (2015, updated 2022), recommendation 1.6.7

Type 2 diabetes in adults: management. NICE guideline NG28 (2015, updated 2022), recommendations 1.6.7 and 1.6.9

Specification

Numerator: The number of patients in the denominator with an HbA1c 75 mmol/mol or less (in the preceding 12 months).

Denominator: The number of patients with diabetes with moderate or severe frailty.

Calculation: Numerator divided by the denominator, multiplied by 100.

Exclusions: Patients without moderate or severe frailty. Patients who had measurement of serum fructosamine instead of HbA1c in previous 12 months. Patients on maximum tolerated diabetes treatment in the previous 12 months.

Minimum population: The indicator would be appropriate to assess performance at individual general practice level.

ISBN: 978-1-4731-6026-2