Endocrinologists' Acceptability and Implementation of Glycated Hemoglobin Targets Among Adults With Type 1 Diabetes.

Objectives: Attainment of the glycated hemoglobin (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 January 16, 2024. The questionnaire consisted of 4 sections: 1) acceptability of the A1C target of ≤7.0%, evaluated by agreement with statements pertaining to the 7 domains of the Theoretical Framework of Acceptability; 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 patients' characteristics on selecting individualized A1C targets different from 7.0%; and 4) respondents' characteristics.

Results: One hundred forty-eight 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 overestimated 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 underemphasized factors when selecting individualized A1C targets.

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