Calculating individualized glycaemic targets using an algorithm based on expert worldwide diabetologists: Implications in real‐life clinical practice

Abstract

Abstract Background The aim of this study was to assess the clinical implications of calculating an individualized HbA 1c target using a recently published algorithm in a real‐life clinical setting. Methods General practitioners (GPs) from the Spanish Society of Family Medicine Diabetes Expert Group were invited to participate in the study. Each GP selected a random sample of patients with diabetes from his or her practice and submitted their demographic and clinical data for analysis. Individualized glycaemic targets were calculated according to the algorithm. Predictors of good glycaemic control were studied. The rate of patients attaining their individualized glycaemic target or the uniform target of HbA 1c < 7.0% was calculated. Results Forty GPs included 408 patients in the study. Of the 8 parameters included in the algorithm, “comorbidities,” “risk of hypoglycaemia from treatment,” and “diabetes duration” had the greatest impact on determining the individualized glycaemic target. Number of glucose‐lowering agents and adherence were independently associated with glycaemic control. Overall, 60.5% of patients had good glycaemic control per individualized target, and 56.1% were well controlled per the uniform target of HbA 1c < 7.0% ( P = .20). However, 12.8% (23 of 246) of the patients with HbA 1c ≥ 7.0% were adequately controlled per individualized target, and 2.6% (6 of 162) of the patients with HbA 1c < 7.0% were uncontrolled since their individualized target was lower. Conclusions In a real‐life clinical setting, applying individualized targets did not change the overall rate of patients with good glycaemic control yet led to reclassification of 7.1% (29 of 408) of the patients. More studies are needed to validate these results in different populations.