Setting explicit glycated haemoglobin goals improves diabetes-related distress, self-efficacy and wellbeing

Background: High levels of diabetes-related distress and low levels of self-efficacy and wellbeing are associated with poorer outcomes in people with diabetes.

Aims: We evaluated the impact of relaxed or stretch HbA1c targets on diabetes-related distress, self-efficacy and wellbeing in adults with type 1 or type 2 diabetes.

Methods: We randomised 50 adults with type 1 or type 2 diabetes to receive HbA1c targets either 5mmol/mol above (relaxed target) or 5mmol/mol below (stretch target) their current HbA1c readings for 3 months. Participants underwent baseline and endpoint evaluation of distress using the Problem Areas in Diabetes (PAID), self-efficacy using the Diabetes Empowerment Scale-Long Form (DES-LF) and wellbeing using the Wellbeing Questionnaire-12 (W-BQ12) validated questionnaires. PAID outputs scores from 0–100 with higher scores indicating higher degrees of distress. W-BQ12 outputs scores from 0–36, with higher scores indicating higher degrees of wellbeing. DES-LF outputs scores from 1–5, with higher scores indicating higher degrees of psychosocial self-efficacy in diabetes.

Results: Thirty-three adults completed endpoint evaluation. Median PAID score significantly reduced by 7.5 (z = 137, p = 0.025) in those with relaxed targets and non-significantly reduced by 4.4 with stretch targets. Mean overall self-efficacy score improved by 0.22 (95% CI 0.04–0.40, p = 0.018) in those with relaxed targets and 0.29 (95% CI -0.05–0.63, p = 0.86) with stretch targets. Median general wellbeing improved by 2.0 in those with relaxed targets and 5.5 with stretch targets at 3 months.

Conclusions: Using specific HbA1c targets is associated with improved levels of distress, self-efficacy, and wellbeing irrespective of the target set. Further studies are needed to evaluate these findings in greater detail.