Despite the increasing focus on individualized diabetes care, current diabetes quality measures are still based on meeting generic HbA1c targets. We proposed an alternative measure to assess the appropriateness (vs. over- or under-treatment) of glucose-lowering therapy that accounts for patient complexity and treatment burden. We worked with OptumLabs® to convene a 12-member modified Delphi panel, selected from among its partner institutions and the NQF Measure Incubator® network, to refine the measure. Members included clinicians (endocrinology, primary care, geriatrics), pharmacists, nurses, researchers, and representatives of public and private health plans. In this study, we examined the factors the panel valued in an ideal appropriateness measure.

Two researchers independently coded panelists’ written responses to a range of questions about the appropriateness measure. Conducting an inductive analysis, codes and overarching themes emerged by consensus. Participants conveyed that an ideal measure must promote individualized care (evidence-based treatments that are consistent with patient psychosocial and biological context, their values and preferences), allow for clinical decision making, and have optimal accountability properties (be easy to implement with reasonable accuracy and reliability, without unintended effects on utilization). Panelists prioritized protecting patient and clinician autonomy, reducing patient treatment burden and clinician punitive potential, and allowing for reasonable clinical exceptions.

Our analysis identified factors that stakeholders value in formulating an appropriateness measure for glucose-lowering therapy. Addressing these factors, and those identified by people with diabetes in subsequent research, may produce a quality measure that strikes a patient-centered balance between glucose control targets and the everyday complexities of being, and treating, people with diabetes.


C.M. LaVecchia: None. V.M. Montori: None. N. Shah: None. R.G. McCoy: None.


American Association of Retired Persons; OptumLabs; National Institute of Diabetes and Digestive and Kidney Diseases (K23DK114497)

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