Objective : An individualized approach is recommended by guidelines when establishing hemoglobin A1c (HbA1c) goals. Setting a goal requires experience and patients often receive conflicting goals among different providers. A recent study validated an algorithm for assessing the recommended HbA1c within a heterogeneous population of primary healthcare providers. The algorithm could help establish glycemic goals and assist other nonprimary care providers by providing more standardized and consistent care recommendations. Few investigations have explored the consensus of HbA1c goals recommended between Ophthalmologists and primary care providers.
We compiled an online survey collecting current recommendations by Ophthalmologists for the proposed HbA1c targets for previously studied clinical vignettes. We also collected recommendations if there was assumed active diabetic retinopathy requiring treatment. Our objective was to compare HbA1c goals between Vitreoretinal Specialists currently treating diabetic retinopathy and with a previously validated algorithm. The clinical cases presented were those used in the previously published study.
The survey was sent to 8 Vitreoretinal providers of whom 5 (62.5%) responded. As recommended by ADA guidelines, healthcare providers individualize their patients’ glycemic goals. The glycemic goals proposed by the Ophthalmic providers were lower than those proposed by the international diabetologists and by an algorithm. This difference was even greater when the Ophthalmologist assumed that the patient was receiving treatment for active retinopathy.
Patients are often given conflicting HbA1c goals from there various providers. It can be confusing for the patient to know where there target HbA1c should be when they are given different goals. Our results suggest that Ophthalmologist treating patients with active retinopathy would benefit from the use of a standard algorithm to help establish glycemic goals. This would help standardized the care recommendations between various types of providers and allow for a more consistent message for the patient.
Conclusion : In summary, our results show that Ophthalmologist recommend a lower HbA1c than that seen in an academic medical center or by primary care providers. That goal was even lower if there was active retinopathy requiring treatment. It has been recommended by the ADA to individualize glycemic goals but there is variability of HbA1c goals among providers. We believe the use of a standard algorithm can help physicians consistently establish glycemic goals across all fields of medicine. This will help send a clear and consistent message to patients with diabetes regarding their HbA1c goals.
Shawnee Mission, Kansas
Blake Cooper started practicing Vireoretinal Surgery in Kansas City 15 years ago after completing his ophthalmology residency and retina fellowship at Washington University in St. Louis/Barnes Hospital. His interest in diabetes is both professional and personal. He is the father of two children, the oldest of which has been living well with T1D since the age of 12.
Amelia Cooper is a freshman at Washington University in St. Louis majoring in PNP (Psychology, Neuroscience, Philosophy). After being diagnosed with Type 1 diabetes at age 12, she has tried to add her voice to the need for better access to care and innovative technologies and medicines. Shortly after diagnosis, she wrote an article for Diatribe regarding being diagnosed and calming parent fears. When she was 15, she was selected for JDRF's Children's Congress, meeting with several lawmakers in Washington DC as part of a concentrated focus on juvenile diabetes research funding. While there, she was asked by Senator McCaskill's office to testify on a Senate Panel regarding continuous glucose monitors. Diatribe had her write an article about her experience testifying before a panel of United States Senators. That experience led her to apply and be accepted as a United States Senate Page during her junior year of high school. At 16, she juggled living in a dorm in Washington DC with going to school in the early mornings and working on the Senate floor each day and sometimes all night. Diabetes Forecast selected her as a "Person to Know" for 2017 as the first person with type one diabetes to serve as a Senate Page and highlighting her advocacy in the field of diabetes. She went on to be the youngest author in the history of Missouri Medicine for her article on teenage life with diabetes. Amelia hopes to go into Public Health and gain access to modernized care for more people.