Quality Standards for Diabetes Care Toolkit

The NZ Primary Care Handbook 2012 outlines the following:

Approach to setting treatment targets:

setting treatment targets is an important component of diabetes management for all patients

targets given for specific parameters are based on best available evidence, but should be appropriate for the individual patient.

Treatment targets to address risk factors:

targets should be appropriate for, and agreed with, the individual patient

treatment targets should be set for an individual in order to balance benefits with harms, in particular hypoglycaemia and weight gain

glycaemic control target: HbA1c 50–55 mmol/mol or as individually agreed

it is important to consider patient age. In younger people, tighter control should be considered given their higher lifetime risk of diabetes-related complications

any reduction in HbA1c is beneficial

good glycaemic control has a clear benefit on microvascular outcomes and if started early enough, on long term macrovascular outcomes

blood pressure (BP) target: <130/80 mm Hg. Evidence suggests a BP target <120 mm Hg may be harmful. Care should be taken to estimate likely treatment response for patients when BP approaches the target of <130 mm Hg

lipids target: triglycerides <1.7 mmol/L; total cholesterol <4.0 mmol/L.
Inzucchi et al (2012) provide the following guidance for managing hyperglycaemia, based on American Diabetes Association guidelines. They describe the figure as a ‘depiction of the elements of decision-making used to determine appropriate efforts to achieve glycaemic targets. Greater concerns about a particular domain are represented by increasing height of the ramp. Thus, characteristics/predicaments toward the left justify more stringent efforts to lower HbA1c, whereas those toward the right are compatible with less stringent efforts. Where possible, such decisions should be made in conjunction with the patient, reflecting his or her preferences, needs, and values. This ‘scale’ is not designed to be applied rigidly but to be used as a broad construct to help guide clinical decisions’ (p 1366).
Figure 2: Approach to management of hyperglycaemia


The American Association of Clinical Endocrinologists outlines the following in their guideline for developing a diabetes mellitus (DM) care plan: Every patient with documented DM requires a comprehensive care plan, which takes into account the individual’s medical history, behaviours and risk factors, ethnic and cultural background, and environment. Glucose targets should take into account remaining life expectancy, duration since diagnosis, presence or absence of microvascular and macrovascular complications, cardiovascular risk factors, comorbid conditions and risk for severe hypoglycaemia.