Glycated haemoglobin targets: The experiences and views of people with diabetes and diabetes healthcare professionals

Background: National guidelines highlight the importance of individualising HbA1c targets. Little is known about the experiences of people with diabetes and diabetes healthcare professionals (HCPs) on the use of HbA1c targets. We explored the experiences of adults with diabetes and diabetes HCPs on the use of glycated haemoglobin targets.

Methods: Qualitative semi-structured interviews were conducted with 14 people with diabetes and seven HCPs in the Northwest UK. Interviews were audio-recorded, transcribed verbatim, and thematically analysed using the Framework method of content analysis.

Results: In people with diabetes, four main themes were identified: (i) motivators (e.g., target achievability, risk of complications, hypoglycaemia avoidance),(ii) demotivators (e.g., lack of understanding, lack of target achievability),(iii) individualisation (e.g., targets catering to functional and social needs, rather than biomedical goals), and (iv) knowledge (e.g., lack of awareness that targets are individualised, information overload). In HCPs, four main themes were identified: (i) treatment targets (e.g., glycaemic target achievability, integrating patients' goals with glycaemic goals),(ii) diabetes care (e.g.,lack of training in managing psychological issues, importance of developing rapport, patient involvement care decisions),(iii) psychological aspects (e.g., use of positive language, impact of psychological issues on self-management), and (iv) physical aspects (e.g., treatment burden, medication side effects).

Conclusions: Determining appropriate individualised HbA1c targets and helping patients achieve targets can be complex. These findings highlight specific motivating and demotivating factors, providing an opportunity to improve healthcare experiences for people with diabetes. Learning from the strategies HCPs utilise may help strike the balance between patient-led social and functional care goals with HCP-led biomedical goals. A shared decision-making process to facilitate this is key.