Type 2 diabetes is diagnosed on an HbA1c of 48 mmol per mol or above. It is not always permanent. A structured weight programme put nearly half of people into remission at one year in a randomised trial. The Core panel including HbA1c is £350 and a consultation is £150.
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Any of these needs to be seen the same day. If you are severely unwell, go to your nearest emergency department or call 999.
Type 2 diabetes is a state where the body’s insulin no longer moves glucose out of the blood effectively. It is diagnosed on an HbA1c of 48 mmol per mol or above, which reflects average blood sugar over the previous 2 to 3 months rather than on the day of the test.World Health Organization WHO/NMH/CHP/CPM/11.1, 2011
It is managed as a cardiovascular condition as much as a sugar one. Blood pressure and lipids are treated alongside the glucose, because the events that shorten life in diabetes are heart attacks and strokes.NICE NG28, 2022
Thirst, passing urine more often, tiredness, blurred vision, recurrent thrush and slow healing. Many people have none of these and are found on a routine test, which is why it is often present for years before it is diagnosed.NICE NG28, 2022
The drivers are weight, particularly around the middle, inactivity, age, and inherited risk that varies by ethnicity. South Asian, African and African Caribbean populations develop it at a lower body weight and at a younger age.NICE PH38, 2017
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One HbA1c of 48 or above confirms it where symptoms are present. Without symptoms the test is repeated to confirm, because a single result can be affected by anaemia, recent blood loss, pregnancy and some haemoglobin variants.World Health Organization WHO/NMH/CHP/CPM/11.1, 2011
The first appointment goes further than the sugar. Kidney function, urine for protein, a full lipid profile, blood pressure, weight and waist, a foot examination for sensation and circulation, and a retinal screening arrangement.NICE NG28, 2022
Your 10 year risk of a heart attack or stroke is worked out in the same visit, since the blood pressure and lipid decisions in diabetes hang on it rather than on the sugar.The BMJ Hippisley Cox, 2017
A structured weight programme aimed at remission
In a randomised primary care trial, 46% of people were in remission at 12 months after a total diet replacement programme, and remission tracked closely with how much weight was kept off. It is not achievable for everybody and it is achievable for more people than are offered it.The Lancet Lean, 2018
Diet and activity without a formal programme
Reduces HbA1c and blood pressure and is the foundation whatever else is used. Its weakness is that people are told to do it and then not given a target or a review date.European Heart Journal ESC guideline, 2021
First line medication
Standard first line treatment lowers HbA1c and has long term safety data behind it. It is started at a low dose and built up to reduce stomach effects.NICE NG28, 2022
Agents chosen for the heart and kidneys
Where there is established cardiovascular disease, heart failure or chronic kidney disease, some classes are chosen for their effect on those outcomes rather than for their effect on the sugar.NICE NG28, 2022
Treating blood pressure and lipids alongside
The interventions with the largest effect on how long somebody with type 2 diabetes lives are frequently not the glucose ones.NICE NG238, 2023
HbA1c reflects 2 to 3 months of average sugar, so it is rechecked at 3 months and not before. A change made this week shows up in the number in the spring, and testing sooner produces a result nobody can act on.NICE NG28, 2022
The inconvenient half of the remission data. In the same trial, remission depended almost entirely on weight kept off, and the people who regained the weight lost the remission. It is a durable result for those who sustain it and it is not a cure.The Lancet Lean, 2018
Foot problems are the complication that changes a life fastest. Sensation and circulation are checked at least annually, and any new break in the skin of the foot is seen the same day rather than watched.NICE NG19, 2019
Ask for your HbA1c in mmol per mol and write down the last three with their dates. The trend over a year tells a doctor more than the latest figure, and it is the single thing most people cannot produce when they are asked.World Health Organization WHO/NMH/CHP/CPM/11.1, 2011
Look at your own feet once a week, including between the toes and the soles with a mirror. Loss of sensation is the reason foot problems are found late, and a weekly look is the cheapest complication prevention there is.NICE NG19, 2019
Measure your waist at the navel after breathing out, and record it monthly. Weight around the middle drives insulin resistance more than total weight, and a falling waist with a static scale is progress the scale will not show you.NICE PH38, 2017
Do not buy a continuous glucose monitor as a first step in type 2 diabetes not treated with insulin. It produces a great deal of data, it costs more than the tests that guide treatment, and for most people it does not change what is done next.NICE NG28, 2022
Do not buy supplements marketed for blood sugar. Chromium, cinnamon and berberine products are sold on small studies with weak endpoints, and the money buys nothing that a structured weight programme does not do better.The Lancet Lean, 2018
Step 1
HbA1c, kidneys, urine, lipids, blood pressure, weight, waist and a foot check, with the 10 year risk calculated at the same visit.
Step 2
Duration since diagnosis, weight and what you are willing to do. Where a structured weight programme is realistic it is offered before medication is escalated.
Step 3
A repeat HbA1c, blood pressure and lipids. The plan is adjusted against measurements rather than against how the last 3 months felt.
Ask before you book if you are not sure this is the right appointment.
It can go into remission. A randomised primary care trial found 46% of people in remission at 12 months after a total diet replacement programme, and remission tracked with the weight kept off. Those who regained the weight lost it again, so it is durable rather than permanent.
An HbA1c of 48 mmol per mol or above. With symptoms one result confirms it. Without symptoms the test is repeated, because anaemia, recent blood loss, pregnancy and some haemoglobin variants all affect the reading.
Every 3 to 6 months while treatment is being adjusted, then every 6 months once it is stable. It reflects 2 to 3 months of average sugar, so testing sooner than 3 months gives a number that nobody can act on.
A 30 minute consultation with examination, feet, blood pressure and the plan is £150. The Core panel with HbA1c, kidneys, liver and lipids is £350. The 3 month review by telephone is £59. Medication is dispensed and priced by the pharmacy.
Not always, and not always straight away. Where the diagnosis is recent and a structured weight programme is realistic, that is offered first. Where medication is needed the class is chosen for your heart and kidneys as well as your sugar.
Because loss of sensation means a foot injury is not felt, and an unfelt injury is found late. Sensation and circulation are checked at least once a year, and any new break in the skin of the foot is a same day problem rather than something to watch.
Usually not, in type 2 diabetes not treated with insulin. It generates a lot of data and for most people it does not change what happens next. Where somebody is on insulin, or the pattern makes no sense on paper, that answer changes.
This page is general information about a condition and it is not a diagnosis. Treatment depends on what a doctor finds when they examine you, and no outcome is guaranteed. If you are severely unwell, or if any of the warnings at the top of this page apply to you, go to your nearest emergency department or call 999.
European Heart Journal, European Society of Cardiology
Guidelines on cardiovascular disease prevention in clinical practiceESC guideline, 2021
NICE
Type 2 diabetes, prevention in people at high riskPH38, 2017
NICE
NICE
Type 2 diabetes in adults, managementNG28, 2022
NICE
Cardiovascular disease, risk assessment and reduction, including lipid modificationNG238, 2023
The BMJ
Development and validation of QRISK3 risk prediction algorithms to estimate future risk of cardiovascular diseaseHippisley Cox, 2017
The Lancet
Primary care led weight management for remission of type 2 diabetes, DiRECTLean, 2018
World Health Organization
Use of glycated haemoglobin HbA1c in the diagnosis of diabetes mellitusWHO/NMH/CHP/CPM/11.1, 2011
Written by the clinical team at The Wellness. Awaiting clinical sign off.
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