Endocrinologists' Acceptability and Implementation of Hemoglobin A1c Targets among Adults with Type 1 Diabetes.

Abstract

Aims: Attainment of the A1C target of ≤7.0% is consistently low among those living with type 1 diabetes (T1D). We evaluated endocrinologists' acceptability and implementation of A1C targets.

Methods: All 309 adult endocrinologists in Ontario were invited to complete an online questionnaire between October 31, 2023 and Jan 16, 2024. The questionnaire consisted of four sections: 1) Acceptability of the A1C target of ≤7.0%, evaluated by agreement with statements pertaining to the seven domains of the Theoretical Framework of Acceptability (TFA); 2) Endocrinologists' perceptions of patient attainment of A1C targets, frequency of setting and discussing A1c targets, common targets used, and open-ended questions regarding A1C targets; 3) Influence of patient characteristics on selecting individualized A1C targets different from 7.0%; and 4) Respondent characteristics.

Results: 148 endocrinologists (48%) completed the questionnaire. Endocrinologists agreed that the A1C target of ≤7.0% is important (87% agreed or strongly agreed) and the correct threshold (75% agreed or strongly agreed). However, endocrinologists over-estimated A1C target attainment among their own patients, and recognized the A1C target of <7.0% may be unrealistic for patients, difficult to achieve, and could cause patient distress. Patients' psychosocial characteristics (such as mental health disorders) and use of technologies (such as continuous glucose monitors and automated insulin delivery systems) emerged as important yet previously under-emphasized factors when selecting individualized A1C targets.

Conclusions: Endocrinologists endorsed the A1C target of ≤7.0%, yet simultaneously expressed concerns regarding its feasibility. Future studies should evaluate how this discrepancy might impact physician discussions and counselling regarding A1C targets.