Endocrinologists’ Acceptability and Implementation of Glycated Hemoglobin Targets Among Adults With Type 1 Diabetes
Bibliographic record
Abstract
OBJECTIVES: Attainment of the glycated hemoglobin (A1C) target of ≤7.0% is consistently low among those living with type 1 diabetes. We evaluated endocrinologists' acceptability and implementation of A1C targets. METHODS: All 309 adult endocrinologists in Ontario were invited to complete an online questionnaire between October 31, 2023, and January 16, 2024. The questionnaire consisted of 4 sections: 1) acceptability of the A1C target of ≤7.0%, evaluated by agreement with statements pertaining to the 7 domains of the Theoretical Framework of Acceptability; 2) endocrinologists' perceptions of patient attainment of A1C targets, frequency of setting and discussing A1C targets, common targets used, and open-ended questions regarding A1C targets; 3) influence of patients' characteristics on selecting individualized A1C targets different from 7.0%; and 4) respondents' characteristics. RESULTS: One hundred forty-eight endocrinologists (48%) completed the questionnaire. Endocrinologists agreed that the A1C target of ≤7.0% is important (87% agreed or strongly agreed) and the correct threshold (75% agreed or strongly agreed). However, endocrinologists overestimated A1C target attainment among their own patients and recognized that the A1C target of <7.0% may be unrealistic for patients, difficult to achieve, and could cause patient distress. Patients' psychosocial characteristics (such as mental health disorders) and use of technologies (such as continuous glucose monitors and automated insulin delivery systems) emerged as important, yet previously underemphasized, factors when selecting individualized A1C targets. CONCLUSIONS: Endocrinologists endorsed the A1C target of ≤7.0%, but simultaneously expressed concerns regarding its feasibility. Future studies should evaluate how this discrepancy may impact physician discussions and counselling regarding A1C targets.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.045 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".