As part of the management of type 2 diabetes, blood pressure and HbA1c levels should be regularly monitored alongside reviewing the patient’s medication for effectiveness. Like all aspects of diabetes management, the frequency of monitoring must be tailored to the individual patient. 

Blood pressure monitoring should be undertaken every one to two months until it is consistently below 140/80mmHg (130/80mmHg if there is kidney, eye or cerebrovascular damage). Thereafter, every four to six months is usual. 

HbA1c monitoring should be undertaken every three to six months, depending on the stability of glycaemic control and treatment. If patients are self€‘monitoring their blood glucose levels, an annual structured assessment is required. Details of what should be included in this assessment can be found in the patient education section of the NICE guideline.

Medicines should be reviewed regularly, and stopped if they are not achieving certain benefits to the patient. For example, GLP-1 mimetic therapy should only be continued if there has been a beneficial metabolic response. This is defined by a reduction of at least 11mmol/mol (one per cent) HbA1c and a weight loss of at least three per cent of initial body weight in six months. Some argue that smaller reductions still constitute a positive outcome and treatment should be continued. 

The MHRA advises that prescribers review pioglitazone treatment after three to six months to ensure that only the patients who are benefiting from the treatment continue. This is because there is a small risk of serious side effects, including bladder cancer. However, the MHRA is not specific about how this benefit is determined beyond requiring a reduction in HbA1c.