P303 Explicit glycated haemoglobin goals improve subsequent HbA1c levels with no impact on health-related quality of life

Published Date: 25th April 2023

Publication Authors: McNulty S, Westall S, Narayanan RP, Irving G, Furlong NJ, Bujawansa S, Cardwell J, Hardy KJ

Background
National guidelines recognise the importance of individualising HbA1c targets. Many people with diabetes agree to have their targets re-evaluated in consultations in response to specific characteristics.

Aims
We aimed to evaluate the impact of relaxed or stretch HbA1c goals on subsequent HbA1c levels and health-related quality of life (HR-QoL) in adults with diabetes.

Methods
We randomised 50 adults with diabetes to receive HbA1c targets either 5mmol/mol above (relaxed target) or 5mmol/mol below (stretch target) current HbA1c readings for 3 months. Participants' HbA1c levels and HR-QoL according to the Euro-QoL-5D-5L (EQ-5D-5L) validated questionnaire were measured at baseline and endpoint. EQ-5D-5L outputs HR-QoL scores (EQ-5D index, range − 0.594–1.000, higher is better) and numerical values from a visual analogue scale (EQ-VAS, range 0–100, higher is better).

Results
Thirty-three individuals completed endpoint evaluation. Sulphonylurea and metformin usage increased 3%. Thiazolidinedione, DPP-4 inhibitor, SGLT-2 inhibitor, GLP-1 receptor agonist, and insulin usage remained unchanged. Mean HbA1c improved by 2.9mmol/mol (95% CI -0.4–6.2,p = 0.084) in those with relaxed targets and 2.8mmol/mol (95% CI -0.2–5.7,p = 0.065) with stretch targets. There was no change in median EQ-5D index or EQ-VAS in those with relaxed targets. Median EQ-5D index worsened by 0.005 and EQ-VAS improved by 5 with stretch targets.

Conclusion
Our findings suggest goal-setting using specific HbA1c targets is associated with improved HbA1c levels irrespective of the target. Median change in EQ-5D-5L scores were below the threshold of minimum clinically important difference. This may indicate the target-setting process, rather than the goal itself, is beneficial for patient HbA1c levels. Further studies are needed to evaluate these findings in greater detail.

Although no causality between severe inpatient hypoglycaemia and death can be inferred from this study because of the observational nature, it does highlight the importance preventing inpatient episodes of hypoglycaemia through effective monitoring and proactive treatment modification.

 

McNulty, S; Westall, SJ; Watmough, S; Narayanan, RP; Irving, G; Furlong, N; Bujawansa, S; Balafshan, T; Cardwell, J; Hardy, K. (2023). P303 Explicit glycated haemoglobin goals improve subsequent HbA1c levels with no impact on health-related quality of life. Diabetic Medicine. 40(S1), pp.158-159. [Online]. Available at: https://doi.org/10.1111/dme.15048 [Accessed 31 July 2023].

 

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