The following are examples of the audit criteria for type 2 diabetes recommended by the National Institute for

Health and Clinical Excellence (NICE). For further details use the link in 'Document references' at the end of this article.1

Blood glucose control

The individual's HbA1c levels should be measured at: o 2-6-monthly intervals until the blood glucose level is stable on unchanging therapy. o 6-monthly intervals once the blood glucose level and blood glucoselowering therapy are stable. Metformin: o Metformin treatment should be started in a person who is overweight or obese, and whose blood glucose is inadequately controlled by lifestyle interventions (nutrition and exercise) alone. o Metformin should be stopped if the serum creatinine exceeds 150 mol/L or the estimated glomerular filtration rate (eGFR) is below 30 ml/minute/1.73m2. Sulfonylureas: o A sulfonylurea should be added as second-line therapy when blood glucose control remains or becomes inadequate with metformin. Thiazolidinediones should not be prescribed to people who have evidence of heart failure or who are at higher risk of fracture. Exenatide: o Exenatide should not be used routinely in type 2 diabetes. Acarbose should only be prescribed for people unable to use other glucoselowering medications. Insulin therapy: o When starting basal insulin therapy: Continue with metformin and the sulfonylurea (and acarbose, if used). o Pioglitazone should be combined with insulin therapy only for: A person who has previously had a marked glucose-lowering response to thiazolidinedione therapy. A person on high-dose insulin therapy whose blood glucose is inadequately controlled.

Cardiovascular risk

Blood pressure should be measured at least annually in a person without previously diagnosed hypertension or renal disease. If a person is not hypertensive, does not have renal disease and their blood pressure is over the target, the measurement should be repeated at the following intervals: o Within 1 month if >150/90 mm Hg. o Within 2 months if >140/80 mm Hg.

Within 2 months if >130/80 mm Hg and kidney, eye or cerebrovascular damage. A blood pressure target of <140/80 mm Hg should be set. A full lipid profile, including high-density lipoprotein (HDL) cholesterol and triglyceride estimations, should be performed: o When assessing cardiovascular risk after diagnosis. o Annually. o Before starting lipid-modifying therapy. People should be receiving low-dose daily aspirin if they are: o Aged 50 or over with blood pressure under 145/90 mm Hg; or o Aged under 50 with significant cardiovascular risk factors. Clopidogrel should only be prescribed to people with a clear aspirin intolerance.
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Other diabetes complications

The following should be carried out annually: o Albumin:creatinine ratio (ACR) estimation on first-pass urine sample or spot sample if necessary. o Serum creatinine measurement. o Estimated glomerular filtration rate. Eye screening should be performed at or around the time of diagnosis. Eye screening should be repeated at least annually. Neuropathic symptoms should be recorded annually.