A Retrospective Chart Review and Comparison of HbA1c Goals to Proposed Calculator Models

Setting individualized goals for glycemic control is widely accepted as standard of care in the management of diabetes mellitus. This requires integration of numerous factors into the goal HbA1c, many of which can be subjective. Few tools are available to assist in goal-setting, including an online calculator based on work by Cahn et al (1). We aimed to evaluate the current practice of setting personalized HbA1c targets at an academic medical center and compare the targets to those derived from the calculator model and the VA/DoD (Department of Defense) DM guidelines (2). A chart review of outpatient diabetes visits in both primary care and diabetes specialty clinics was performed from 11/2019-12/2020. Documentation of HbA1c goals was assessed. All patient factors that contribute to goal-setting were gathered and a proposed HbA1c goal via calculator model and VA/DoD guidelines was set for each patient. A comparison between these HbA1c goals was conducted. Of the 100 patient charts reviewed, only 25% (25/100) included a specified goal HbA1c. Of those, 88% (22/25) of the clinicians’ goals matched the calculated HbA1c goal, whereas only 32% (8/25) matched the estimated HbA1c based on VA/DoD guidelines. Documentation of individualized glycemic targets in the management of DM is not routinely practiced. When HbA1c goals are specified, they tend to correlate well with suggested goals obtained via a comprehensive calculator and less so with guidelines that rely heavily on a clinician’s subjective assessment. These findings suggest an opportunity to provide further education on setting individualized goals of care in the management of DM, as well as the utility of calculator models in assisting clinicians in daily practice. Cahn A, et al. Clinical Assessment of Individualized Glycemic Goals⋯ Diabetes Care. 2015;38(12):2293-2300.VA/DoD Clinical Practice Guideline for the Management of Type 2 DM in Primary Care. https://www.healthquality.va.gov/guidelines/CD/diabetes/VADoDDMCPGFinal508.pdf. Disclosure A. C. Zuzek: None. C. Kelly: None. L. Sayyed kassem: None. A. Rajpal: None.