title: Poor achievement of guidelines-recommended targets in type 2 diabetes: findings from a contemporary prospective cohort study.
abstract: OBJECTIVE
  To prospectively evaluate diabetes management in the primary care setting and explore factors related to guideline-recommended triple target achievement [blood pressure (BP) ≤ 130/80 mmHg, A1C ≤ 7% and low-density lipoprotein (LDL)-cholesterol < 2.5 mmol/l].
  
  
  METHODS
  Baseline, 6 and 12 month data on clinical and laboratory parameters were measured in 3002 patients with type 2 diabetes enrolled as part of a prospective quality enhancement research initiative in Canada. A generalised estimating equation model was fitted to assess variables associated with triple target achievement.
  
  
  RESULTS
  At baseline, 54%, 53% and 64% of patients, respectively, had BP, A1C and LDL-cholesterol at target; all three goals were met by 19% of patients. The percentage of individuals achieving these targets significantly increased during the study [60%, 57%, 76% and 26%, respectively, at the final visit, p < 0.0001 except for A1C, p = 0.27]. A much smaller proportion of patients had adequate control during the entire study period [30%, 39%, 53% and 7%, respectively]. In multivariable analysis, women, patients younger than 65 years and patients of Afro-Canadian origin were less likely to achieve the triple target.
  
  
  CONCLUSIONS
  As part of a quality enhancement research initiative, we observed important improvements in the attainment of guidelines-recommended targets in patients with type 2 diabetes followed for a 12-month period in the primary care setting; however, many individuals still failed to achieve and especially maintain optimal goals for therapy, particularly the triple target. Results of the multivariable analysis reinforce the need to address barriers to improve diabetes care, particularly in more susceptible groups.
authors.affiliation: Department of Medicine, Division of Endocrinology & Metabolism, McMaster University, Hamilton, ON, Canada.
authors.forename: M F B
authors.initials: MF
authors.lastname: Braga
authors.forename: A
authors.initials: A
authors.lastname: Casanova
authors.forename: H
authors.initials: H
authors.lastname: Teoh
authors.forename: H C
authors.initials: HC
authors.lastname: Gerstein
authors.forename: D H
authors.initials: DH
authors.lastname: Fitchett
authors.forename: G
authors.initials: G
authors.lastname: Honos
authors.forename: P A
authors.initials: PA
authors.lastname: McFarlane
authors.forename: E
authors.initials: E
authors.lastname: Ur
authors.forename: J-F
authors.initials: JF
authors.lastname: Yale
authors.forename: A
authors.initials: A
authors.lastname: Langer
authors.forename: S G
authors.initials: SG
authors.lastname: Goodman
authors.forename: L A
authors.initials: LA
authors.lastname: Leiter
mesh_terms: D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure / Q000502:physiology; D001835:Body Weight; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D003925:Diabetic Angiopathies / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D050356:Lipid Metabolism; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents; D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D000960:Hypolipidemic Agents; D010975:Platelet Aggregation Inhibitors