Summary: In a feasibility study in adults with diabetes, setting an explicit HbA1c target either above or below the current value made no significant difference to glucose or patient-reported outcomes, but the process was highly acceptable and, across everyone, distress fell and self-efficacy and HbA1c improved.
PICO Summary
| Element | Detail |
|---|---|
| Population | 50 adults with diabetes (34% withdrew); randomised mixed-methods feasibility study, UK. |
| Intervention | An explicit HbA1c target set 5 mmol/mol below the participant’s current HbA1c (Group B). |
| Comparison | An explicit HbA1c target set 5 mmol/mol above the current HbA1c (Group A). |
| Outcome | The study was not powered for significance, and no between-group differences were seen in HbA1c or patient-reported outcomes. Across both groups, diabetes distress decreased, self-efficacy improved, and HbA1c improved. Interviews showed high acceptability, with motivators (achievability, hypoglycaemia avoidance) and demotivators (limited understanding, perceived unattainability). |
Expert Commentary
This is a feasibility study, and reading it as one is essential: its purpose was to test whether a definitive trial of explicit HbA1c target-setting could be run and would be acceptable, not to prove the intervention works, so the absence of between-group differences should not be over-interpreted as a negative result. What it does show is encouraging for further research, namely that patients and clinicians found documented, individualised target-setting acceptable, and that engagement around goals coincided with lower distress and better self-efficacy across the board. The most useful methodological signals are practical, the 34% withdrawal rate, which any future trial must plan for, and the qualitative insight that targets only motivate when they feel achievable and relevant. Limitations are inherent to the design: underpowered for glycaemic endpoints, an arbitrary 5 mmol/mol differential that may not be the optimal motivational calibration, a research population that may be more engaged than usual, short follow-up, and no usual-care arm, so improvements may partly reflect attention. Can I use this with my patients? Yes, as gentle endorsement of practice I already follow. It supports collaborative, individualised target-setting as a behavioural element of care, framed to feel attainable, while I await an adequately powered trial before claiming it changes glycaemic outcomes.
References
Westall SJ, Watmough S, Narayanan RP, Irving G, Hardy KJ. Feasibility of glycated haemoglobin target-setting in adults with diabetes: a mixed-methods study. PLoS One. 2026;21(1):e0317162. doi:10.1371/journal.pone.0317162