Explicit glycated haemoglobin goals improve subsequent HbA1c levels with no impact on health-related quality of life.

Background: National guidelines recognise the importance of individualising HbA1c targets. Many people with diabetes agree to have their targets re-evaluated in consultations in response to specific characteristics.

Aims: We aimed to evaluate the impact of relaxed or stretch HbA1c goals on subsequent HbA1c levels and health-related quality of life (HR-QoL) in adults with diabetes.

Methods: We randomised 50 adults with diabetes to receive HbA1c targets either 5mmol/mol above (relaxed target) or 5mmol/mol below (stretch target) current HbA1c readings for 3 months. Participants' HbA1c levels and HR-QoL according to the Euro-QoL-5D-5L (EQ-5D-5L) validated questionnaire were measured at baseline and endpoint. EQ-5D-5L outputs HR-QoL scores (EQ-5D index, range − 0.594–1.000, higher is better) and numerical values from a visual analogue scale (EQ-VAS, range 0–100, higher is better).

Results: Thirty-three individuals completed endpoint evaluation. Sulphonylurea and metformin usage increased 3%. Thiazolidinedione, DPP-4 inhibitor, SGLT-2 inhibitor, GLP-1 receptor agonist, and insulin usage remained unchanged. Mean HbA1c improved by 2.9mmol/mol (95% CI -0.4–6.2,p = 0.084) in those with relaxed targets and 2.8mmol/mol (95% CI -0.2–5.7,p = 0.065) with stretch targets. There was no change in median EQ-5D index or EQ-VAS in those with relaxed targets. Median EQ-5D index worsened by 0.005 and EQ-VAS improved by 5 with stretch targets.

Conclusions: Our findings suggest goal-setting using specific HbA1c targets is associated with improved HbA1c levels irrespective of the target. Median change in EQ-5D-5L scores were below the threshold of minimum clinically important difference. This may indicate the target-setting process, rather than the goal itself, is beneficial for patient HbA1c levels. Further studies are needed to evaluate these findings in greater detail.