GLYCATED HEMOGLOBIN AND METABOLIC CONTROL OF DIABETES-MELLITUS - EXTERNAL VERSUS LOCALLY ESTABLISHED CLINICAL TARGETS FOR PRIMARY-CARE

Objectives-To examine current targets for glycated haemoglobin as a ma rker for metabolic control in diabetes mellitus in relation to dataset s from several areas, and to consider whether target setting could be improved. Design-Data collected from enhanced care records of general practices for a representative community based sample of people with d iabetes. Setting and subjects-3022 people with diabetes on the lists o f 37 general practices (total list size 222 550) in South Glamorgan in 1992; samples of glycated haemoglobin had been processed at two labor atories with different methodologies and reference ranges. Main outcom e measures-Last glycated haemoglobin level measured in subjects for 19 92 and published data from other studies considered in relation to exi sting goals and standards for the metabolic control of diabetes. Resul ts-An ascertainment rate for people with diabetes of 1.36% was obtaine d. The rate of data capture for haemoglobin A1 was 75.7%, and the mean level for study samples was 10.5% at one laboratory and 10.0% at the other (similar values to those of comparable studies). These mean leve ls of haemoglobin A1 in representative populations of people with diab etes are poor or very. poor according to published standards, includin g those of the British Diabetic Association. These findings are set in the context of the psychology of goal setting and performance in comp lex clinical situations. Conclusion-Targets for clinical care that are set in the absence of normative data and local feasibility assessment s should be treated with caution. Targets are more likely to enhance h ealth care if target setters recognise the importance of psychological aspects of goal setting and motivation.