Summary:
In adults with diabetes, individualized HbA1c target-setting (5 mmol/mol higher or lower than current HbA1c) did not significantly impact glycaemic outcomes or patient-reported measures compared to alternate target assignment group, though it was associated with high acceptability and improvements in diabetes distress and self-efficacy.
| PICO | Description |
|---|---|
| Population | Adults with diabetes participating in a randomised feasibility trial evaluating HbA1c target-setting. |
| Intervention | Explicit HbA1c targets set to 5 mmol/mol below participants’ baseline HbA1c levels (Group B). |
| Comparison | HbA1c targets set 5 mmol/mol above participants’ baseline HbA1c levels (Group A). |
| Outcome | No significant between-group differences were found in HbA1c or psychometric outcomes. Across all participants, HbA1c decreased, diabetes-related distress declined, and self-efficacy improved. The target-setting process was deemed acceptable by patients and healthcare professionals. Motivational impact varied depending on goal achievability and perceived relevance. |
Clinical Context
Individualized glycemic targets have become a cornerstone of contemporary diabetes care, with professional guidelines emphasizing patient-centered goal-setting rather than universal HbA1c thresholds. However, the actual process of setting and communicating explicit HbA1c targets with patients has received limited research attention. While clinicians routinely discuss glycemic control, whether formally establishing personalized numerical targets influences patient behavior, motivation, or outcomes remains uncertain. Goal-setting theory from behavioral psychology suggests that specific, challenging yet achievable targets can enhance motivation and performance, but translating these principles to chronic disease management requires empirical validation. Additionally, concerns exist that overly ambitious targets could increase diabetes distress while easily achieved targets might fail to motivate improvement. This mixed-methods feasibility study explored whether explicit, individualized HbA1c target-setting is acceptable to patients and healthcare professionals and whether it influences glycemic and psychological outcomes.
Clinical Pearls
- Setting explicit HbA1c targets either 5 mmol/mol above or below baseline did not produce significant differences in glycemic outcomes between groups, though all participants showed improvement regardless of target direction.
- The target-setting process itself demonstrated high acceptability among both patients and healthcare professionals, suggesting feasibility for integration into routine clinical care.
- Across all study participants, diabetes-related distress decreased and self-efficacy improved, indicating potential benefits from the attention and engagement inherent in the target-setting process.
- Individual responses to targets varied considerably based on whether goals were perceived as achievable and personally relevant, highlighting the importance of tailoring approaches to patient characteristics.
Practical Application
Clinicians should consider incorporating explicit, documented HbA1c targets into diabetes care conversations, recognizing that the process itself may provide psychological benefits even when targets don’t significantly alter glycemic trajectories. Target-setting should be individualized based on patient circumstances, comorbidities, and life expectancy as recommended by guidelines. When setting targets, clinicians should assess whether goals feel achievable and meaningful to patients, as motivational impact depends heavily on these perceptions. Patients who find targets stressful or irrelevant may not benefit, while those who engage positively with goal-oriented approaches may show enhanced self-efficacy. The key insight is that target-setting represents a behavioral intervention requiring thoughtful implementation rather than simply assigning a number.
Broader Evidence Context
These findings align with the broader shift toward personalized diabetes management that recognizes variability in patient responses to care approaches. The psychological benefits observed are consistent with literature on patient engagement and self-management support, where attention and collaborative goal-setting often produce improvements independent of specific intervention content. The lack of differential effect between tighter and looser targets parallels findings from major glycemic control trials showing that the relationship between targets and outcomes is more nuanced than simply “lower is better.” This study contributes preliminary evidence supporting the feasibility of further research into target-setting as a behavioral intervention component.
Study Limitations
- As a feasibility study, the sample size was not powered to detect clinically meaningful differences in glycemic outcomes between target groups.
- The arbitrary 5 mmol/mol differential may not represent optimal target calibration for motivational purposes.
- Participants in a research study may differ from typical clinical populations in motivation and engagement levels.
- The relatively short follow-up period may not capture longer-term effects of sustained target-oriented care.
- Both groups received attention from the target-setting process, potentially obscuring differences compared to usual care without explicit targets.
Bottom Line
Explicit HbA1c target-setting is acceptable to patients and healthcare professionals and may improve diabetes distress and self-efficacy regardless of whether targets are set above or below current glycemic levels. While target direction did not significantly impact outcomes, the process of collaborative goal-setting itself appears beneficial and merits integration into diabetes care.
Source: Samuel J Westall, et al. “Feasibility of glycated haemoglobin target-setting in adults with diabetes: A mixed-methods study.” Read article here.
