Recent updates in Type 2 Diabetes management

Notice of HbA1c diagnostic threshold changes in brief^1,2:

• New HbA1c criteria define normal as under 42 mmol/mol, prediabetes as 42-47, and diabetes as 48 or higher; no confirmation is needed if HbA1c is 53 mmol/mol or above.  

• Vildagliptin should not be added to dulaglutide, as both act on GLP‑1 pathways. 

• In pregnancy, all diabetes medications, including ACE inhibitors and statins, are stopped, with only metformin and insulin used, and all pregnant women require secondary care input.  

• People with diabetes who also have heart or kidney failure benefit from SGLT2 inhibitors, specifically empagliflozin, in New Zealand.  

• Primary care must also address therapeutic inertia and screen for diabetes distress or depression, which can affect glycaemic control. 

This Gem has been approved by Dr Helen Snell. References:

1. Notice of Updated HbA1c Diagnostic Thresholds from 1 July 2026. Health NZ

2. Type 2 Diabetes Management Goodfellow podcast (2026)

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