Comment on Shahraz et al. Do Patient Characteristics Impact Decisions by Clinicians on Hemoglobin A1c Targets? Diabetes Care 2016;38:e145-e146

Comparison of HBA1c Goals Proposed by an Algorithm To Those Set By Different Members of Healthcare Teams Within the Dartmouth Hitchcock Health System

OBJECTIVE

An individualized approach is recommended by guidelines when establishing hemoglobin A1c (HbA1c) goals. Setting a goal requires experience and awareness; it is time consuming and not always trivial. A previous study proposed an algorithm for assessing the recommended HbA1c target according to individual patient characteristics. Few investigations have explored the variation of HbA1c goals recommended among different types of providers.

METHODS

We conducted a survey regarding practice settings, practices related to diabetes mellitus type 2, and HbA1c targets recommended to patients. Our objective was to compare HbA1c goals between Dartmouth Hitchcock Healthcare System providers (including endocrinology department, general internal medicine, and family medicine providers) and a previously validated algorithm. The clinical cases presented were those used in the previously published study.

RESULTS

The survey was sent to 228 healthcare providers of whom 81 (35.5%) responded. As recommended by the guidelines, healthcare providers individualize their patients' glycemic goals. The glycemic goals proposed by the providers in our institution were similar to those proposed by the international diabetologists and by the algorithm.

CONCLUSION

Our results further validate the proposed algorithm within a heterogeneous population of healthcare providers. The algorithm could help establish glycemic goals and assist healthcare systems in providing more standardized care.

ABBREVIATIONS

ADA = American Diabetes Association; APRN = advanced practice registered nurse; DH = Dartmouth Hitchcock Healthcare System; FM = family medicine; GIM = general internal medicine; HbA1c = hemoglobin A1c; PA-C = certified physician assistant.