Article: Care Delivery Experiences of using blood glucose targets when following an intensive insulin regimen: a qualitative longitudinal investigation involving patients with Type 1 diabetes D. Rankin 1 , D. D. Cooke 2 , S. Heller 3 , J. Elliott 3 , S. Amiel 4 and J. Lawton 1 for the UK National Institute for Health Research (NIHR) Dose Adjustment for Normal Eating (DAFNE) Study Group 1 Centre for Population Health Sciences, University of Edinburgh, Edinburgh, 2 Epidemiology and Public Health, University College London, 3 Academic Unit of Diabetes, Endocrinology and Metabolism, University of Sheffield, Sheffield and 4 Division of Diabetes and Nutritional Sciences, King’s College London, UK Accepted 30 March 2012 Abstract Aims Use of blood glucose targets is considered essential to help patients with Type 1 diabetes achieve tight glycaemic control following structured education. To foster effective use of blood glucose targets, we explored patients’ experiences and views of implementing clinically recommended blood glucose targets after attending a structured education programme promoting intensive insulin treatment. Methods Repeat, in-depth interviews with 30 patients with Type 1 diabetes recruited from Dose Adjustment for Normal Eating (DAFNE) courses in the UK. Data were analysed using an inductive, thematic approach. Results Patients found use of blood glucose targets motivational. Targets enabled patients to identify problems with blood glucose control and prompted them to make insulin dose adjustments independently, or with assistance. However, patients tended to adapt or simplify targets over time to: make them more attainable and easy to remember; reduce risk of hypoglycaemia; and, mitigate feelings of failure when attempts to attain clinically defined targets were unsuccessful. Some patients were advised to use elevated targets to counter hypoglycaemia unawareness and required help from health pro- fessionals to determine when / if these should be reduced. Conclusions Although blood glucose targets are an important component of diabetes self-management, patients may adapt and personalize them over time, sometimes inadvertently, with a potentially detrimental impact on long-term glycaemic control. Blood glucose targets should be regularly revisited during clinical reviews and revised / new targets agreed to accommodate patients’ concerns and difficulties. Other interventions may need to be considered to promote effective use of blood glucose targets. Diabet. Med. 29, 1079–1084 (2012) Keywords blood glucose targets, intensive insulin therapy, qualitative longitudinal research, structured education programme, Type 1 diabetes Abbreviation DAFNE, Dose Adjustment for Normal Eating Introduction Patients with Type 1 and Type 2 diabetes who achieve near normoglycaemia can significantly reduce their risk of complications [1–4]. HbA 1c , a marker of average blood glucose, is used as an index of metabolic control in clinical practice and patients with Type 1 diabetes are advised to attain readings < 53 mmol / mol (< 7%). However, the HbA 1c test is of no practical use during routine self-management and self- monitoring of blood glucose is recommended to enable patients to: detect day-to-day and / or intra-day glycaemic excursions; identify and resolve hypoglycaemia; and, make appropriate treatment choices that take account of lifestyle and medication regimens [5,6]. Correspondence to: D. Rankin, Centre for Population Health Sciences, University of Edinburgh, Teviot Place, Edinburgh EH8 9AG, UK. E-mail: a.d.rankin@ed.ac.uk DIABETICMedicine DOI: 10.1111/j.1464-5491.2012.03670.x ª 2012 The Authors. Diabetic Medicine ª 2012 Diabetes UK 1079