Introduction & Objective: ​​Most adults with T1D do not meet the HbA1c target of ≤7.0%. Endocrinologists’ perceptions may influence target attainment among patients, but have not been previously evaluated. We evaluated endocrinologists’ acceptability of the HbA1c target of ≤7.0%.

Methods: An online REDCap survey was sent to all 309 adult endocrinologists in Ontario. Acceptability of the HbA1c target of ≤7.0% was assessed using the Theoretical Framework of Acceptability (TFA), which evaluates interventions according to seven domains: affective attitude (feelings), burden (required effort), perceived effectiveness (likelihood of achieving purpose), ethicality (fit with personal values), intervention coherence (understanding), opportunity costs (potential negative effects), and self-efficacy (confidence). Agreement with statements representing each domain was rated by 5-point Likert scale. Acceptability was considered high if the proportion agreeing or strongly agreeing (A/SA) was >70% (or proportion disagreeing or strongly disagreeing was <30% for opportunity costs domain).

Results: 120 eligible endocrinologists (39%) completed the survey [69 (58%) female, 95 (82%) urban practice, and 53 (46%) aged 30-40 years]. TFA domains with high acceptability were intervention coherence (91% A/SA), ethicality (87% A/SA) and affective attitude (75% A/SA). Domains with low acceptability were self-efficacy (46% A/SA), perceived effectiveness (67% A/SA), burden (35.8% A/SA) and opportunity costs (33% disagree/strongly disagree). Responses suggest a disconnect whereby endocrinologists highly value the HbA1c target of ≤7.0% but perceive challenges in implementation.

Conclusion: Endocrinologists’ endorsement of the HbA1c target despite acknowledged barriers to implementation could negatively influence the physician-patient relationship. The potential benefits and risks of alternative patient-centered HbA1c targets requires further exploration.

Disclosure

S. Kaushal: None. I. Halperin: Advisory Panel; Dexcom, Inc. Speaker's Bureau; Dexcom, Inc., Novo Nordisk, Sanofi. Advisory Panel; Sanofi, Abbott. Speaker's Bureau; Tandem Diabetes Care, Inc. G.A. Hawker: None. A. Weisman: None.

Funding

Banting & Best Diabetes Centre Sunlife Financial New Investigator Award

© 2024 by the American Diabetes Association
2024
Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at http://www.diabetesjournals.org/content/license.