Type 2 diabetes: Goals for optimum management

Individual goals 

Encourage all people with type 2 diabetes to approach/reach these goals 

Diet 

Advise individual dietary reviews 

Refer to ‘Lifestyle interventions for the management of type 2 diabetes: Diet’ 

BMI 

Advise a goal of 5–10% weight loss for people who are overweight or obese with type 2 diabetes 

Refer to ‘Weight management interventions for type 2 diabetes’ 

Physical activity 

Children and adolescents: Aim for at least 60 min/day of moderate to vigorous physical activity, plus muscle- and bone-strengthening activities at least three days per week 

Adults: Aim for 150 minutes of aerobic activity, plus two to three sessions of resistance exercise (to a total of ≥60 minutes), per week 

Refer to ‘Lifestyle interventions for the management of type 2 diabetes: Physical activity’ 

Cigarette consumption 

Zero per day 

Refer to ‘Lifestyle interventions for the management of type 2 diabetes: Smoking cessation’ 

Alcohol consumption 

No more than 10 standard drinks per week and four on any one day 

Refer to ‘Lifestyle interventions for the management of type 2 diabetes: Alcohol consumption’ 

Blood glucose monitoring 

Advise 4–7 mmol/L fasting and 5–10 mmol/L postprandial blood glucose levels 

SMBG is recommended for patients with type 2 diabetes who are using sulfonylureas and/or insulin. Education should be provided regarding the frequency and timing of insulin dose based on SMBG 

For people not on insulin, the need for and frequency of SMBG should be individualised, depending on the type of glucose-lowering medications, level of glycaemic management and risk of hypoglycaemia, as an aid to self-management 

SMBG is recommended in pregnancy complicated with diabetes or gestational diabetes 

SMBG is also recommended for people with hyperglycaemia arising from intercurrent illness (see ADEA clinical guidelines for sick days). It may be helpful in haemoglobinopathies or other conditions where HbA1c measurements may be unreliable 

ADEA, Australian Diabetes Educators Association; BMI, body mass index; HbA1c, glycated haemoglobin; SMBG, self-monitoring of blood glucose. 

Clinical management goals  

Treatment targets for people with type 2 diabetes include the following. For a comprehensive list of assessments and screening intervals, refer to ‘Assessment of the patient with type 2 diabetes’. 

HbA1c 

Target needs individualisation according to patient circumstances 

Generally ≤7% (53 mmol/mol) 

Lipids 

Initiation of pharmacotherapy in primary prevention is dependent on the assessment of absolute CVD risk (refer to the Australian CVD risk calculator, which assess multiple risk factors and summates risk rather than using individual parameters). 

Once therapy is initiated, Australian guideline-specified targets should be used as a guide to treatment. For secondary prevention, treatment to target an LDL cholesterol reduction of ≥50% from baseline and an LDL cholesterol goal of <1.4mmol/L 

Blood pressure 

Treatment targets should be individualised and monitored for side effects from medications used to lower blood pressure 

Lower blood pressure targets may be considered for younger people and for secondary prevention in those at high risk of stroke 

The target for people with diabetes and CKD remains <130/80 mmHg. 

However, ≤140/90 mmHg is still considered a general target (see the Heart Foundation’s 2016 Guideline for the diagnosis and management of hypertension in adults) 

Urine albumin excretion 

UACR: 

• Women: <3.5 mg/mmol 
• Men: <2.5 mg/mmol 

Timed overnight collection: <20 μg/min; spot collection: <20 mg/L 

Vaccination 

Recommended immunisations: influenza, pneumococcus, dTpa, COVID-19 

Consult the Australian immunisation handbook for specific advice 

Consider: RSV (age >60 years), hepatitis B (if travelling), herpes zoster 

CKD, chronic kidney disease; CVD, cardiovascular disease; dTpa, diphtheria-tetanus-acellular pertussis; HbA1c, glycated haemoglobin; LDL, low-density lipoprotein; RSV, respiratory syncytial virus; UACR, urine albumin-to-creatinine ratio.