1110-P: Endocrinologists' Perceptions and Implementation of Hemoglobin A1c Targets for Adults with Type 1 Diabetes

This is the authors' abstract. We don't add key points for this paper.

Introduction & Objective: ​​Most adults with T1D do not meet the HbA1c target of ≤7.0%. Endocrinologists’ perceptions may influence target attainment among patients, but have not been previously evaluated. We evaluated endocrinologists’ acceptability of the HbA1c target of ≤7.0%. Methods: An online REDCap survey was sent to all 309 adult endocrinologists in Ontario. Acceptability of the HbA1c target of ≤7.0% was assessed using the Theoretical Framework of Acceptability (TFA), which evaluates interventions according to seven domains: affective attitude (feelings), burden (required effort), perceived effectiveness (likelihood of achieving purpose), ethicality (fit with personal values), intervention coherence (understanding), opportunity costs (potential negative effects), and self-efficacy (confidence). Agreement with statements representing each domain was rated by 5-point Likert scale. Acceptability was considered high if the proportion agreeing or strongly agreeing (A/SA) was >70% (or proportion disagreeing or strongly disagreeing was <30% for opportunity costs domain). Results: 120 eligible endocrinologists (39%) completed the survey [69 (58%) female, 95 (82%) urban practice, and 53 (46%) aged 30-40 years]. TFA domains with high acceptability were intervention coherence (91% A/SA), ethicality (87% A/SA) and affective attitude (75% A/SA). Domains with low acceptability were self-efficacy (46% A/SA), perceived effectiveness (67% A/SA), burden (35.8% A/SA) and opportunity costs (33% disagree/strongly disagree). Responses suggest a disconnect whereby endocrinologists highly value the HbA1c target of ≤7.0% but perceive challenges in implementation. Conclusion: Endocrinologists’ endorsement of the HbA1c target despite acknowledged barriers to implementation could negatively influence the physician-patient relationship. The potential benefits and risks of alternative patient-centered HbA1c targets requires further exploration. Disclosure S. Kaushal: None. I. Halperin: Advisory Panel; Dexcom, Inc. Speaker's Bureau; Dexcom, Inc., Novo Nordisk, Sanofi. Advisory Panel; Sanofi, Abbott. Speaker's Bureau; Tandem Diabetes Care, Inc.