Do Patient Characteristics Impact Decisions by Clinicians on Hemoglobin A1c Targets?

In setting hemoglobin A1c (HbA1c) targets, physicians must consider individualized risks and benefits of tight glycemic control (1,2) by recognizing that the risk-benefit ratio may become unfavorable in certain patients, including the elderly and/or those with multiple comorbidities (3,4). Customization of treatment goals based on patient characteristics is poorly understood, partly due to insufficient data on physicians’ decisions in setting targets. We used the National Health and Nutrition Examination Survey (NHANES) to analyze patient-reported HbA1c targets set by physicians and to test whether targets are correlated with patient characteristics.Data from the NHANES waves 2005–2006, 2007–2008, 2011–2012, and 2013–2014 (the 2009–2010 wave lacked HbA1c data) comprised 2,641 individuals with self-reported diabetes, of which 1,782 responded to the question, “What does [your doctor] say [your] ‘A1C’ level should be?” On the basis of the distribution of responses, we analyzed the following targets: <6%, <7%, and higher cutoffs (<8%, 9%, and 10%) combined. Using ordered logistic regression, we assessed the influence of age; sex; race; diabetes duration; comorbidities; BMI; variables on physical, mental, and biological health; and health care utilization. We used NHANES sample weights to calculate population rates of target HbA …