UK diabetes care is built around a single number: HbA1c. Hit the target, and you're "well controlled." Miss it, and medications get added. This framework is simple. It's also incomplete.
Beyond HbA1c
Time in range. Continuous glucose monitors (CGMs) have revealed that two patients with identical HbA1c values can have vastly different glucose profiles. One may have stable glucose all day. The other may swing between dangerous highs and lows that average out to the same number. Time in range — the percentage of time your glucose stays between 3.9 and 10 mmol/L — is increasingly recognised as a better measure of glucose control than HbA1c alone.
Cardiovascular risk management. For Type 2 diabetes, the leading cause of death isn't glucose — it's cardiovascular disease. Yet many diabetes reviews focus almost exclusively on glucose control. Blood pressure, lipids, ApoB, kidney function, and smoking status are at least as important as HbA1c in determining long-term outcomes.
Medication optimisation. The landscape of diabetes medication has transformed. GLP-1 receptor agonists and SGLT2 inhibitors offer cardiovascular and renal protection beyond glucose lowering. If you're on metformin alone and have additional cardiovascular risk factors, you may benefit from medications that aren't being offered because your HbA1c is "fine."
Getting better diabetes care
Ask for a comprehensive annual review that goes beyond HbA1c: full cardiovascular risk assessment, kidney function, eye screening, foot assessment, and a conversation about whether your current medication regimen is optimal — not just adequate.
If you're not getting this level of care through your GP, a diabetes specialist nurse or consultant diabetologist can provide it — either through NHS referral or privately.
Related: Heart Disease Prevention: What Your GP Isn't Telling You