Why Meeting Diabetes Care Targets Remains a Challenge—Even at Top Hospitals

Doctors and health organizations have clear targets for managing diabetes. These include keeping blood sugar (HbA1c) under 7%, maintaining blood pressure at or below 130/80 mmHg, and keeping LDL cholesterol at 2.6 mmol/L or lower. These targets are designed to reduce the risk of serious complications like heart disease, kidney damage, and eye problems.

Yet in practice, many people with diabetes don't reach these goals. This isn't a problem limited to small clinics or under-resourced areas—it shows up even at major tertiary hospitals, the highest level of care in most healthcare systems.

Researchers in Rwanda studied 400 adults with diabetes at four major tertiary hospitals between September 2023 and April 2024. The group included people with Type 1 diabetes who had been followed for at least 5 years, and people with Type 2 diabetes with at least 12 months of care records.

The team collected detailed information through interviews, physical exams, and lab work to see how many patients actually met the recommended targets for blood sugar, blood pressure, and cholesterol. They also looked at how often diabetic retinopathy—damage to the blood vessels in the eye—was present and what factors were connected to it.

For people living with Type 1 diabetes, hitting these care targets requires consistent effort: regular insulin dosing, frequent blood sugar monitoring, healthy eating, physical activity, and routine checkups. The targets aren't arbitrary—they're based on evidence showing that better control reduces the risk of long-term complications.

When targets aren't met across a population—even at well-staffed hospitals—it signals that barriers exist. These might include access to medications and supplies, time constraints, patient education gaps, or healthcare system challenges. Understanding these obstacles is the first step toward addressing them.

One key finding is that diabetic retinopathy—progressive damage to the retina that can lead to vision loss—was tied to how well patients met their care goals. This underscores why achieving targets like HbA1c control matters in practice, not just in theory.

Better diabetes control means lower risk of retinopathy and other complications. The reverse is also true: when care goals aren't met, the risk of these serious outcomes rises. This is true for both Type 1 and Type 2 diabetes.

Studies like this one help identify where and why people with diabetes struggle to reach their targets. The findings from Rwanda—a country actively strengthening its healthcare infrastructure—can point to solutions that work in similar settings worldwide.

For individuals managing Type 1 diabetes, the takeaway is clear: work with your care team to set realistic targets, understand what you're aiming for and why, and discuss any barriers you face. Achieving these goals takes partnership between patients and healthcare providers, plus access to the right tools and support.

Source: BMC endocrine disorders. Evidence type: PubMed indexed literature. Type1Cure is an information and intelligence hub, not a medical advice service. This article summarizes published research and does not provide diagnosis, treatment, or personal medical guidance. Always talk to your own care team before changing anything about your Type 1 diabetes management.