title: Room for improvement in diabetes care among First Nations in northern Quebec (Eeyou Istchee): reasonable management of glucose but poor management of complications.
abstract: OBJECTIVE
  To evaluate the clinical management of type 2 diabetes in the Eeyou Istchee communities of northern Quebec.
  
  
  METHODS
  Retrospective quality assurance audit.
  
  
  METHODS
  Patients with diabetes were identified using the Cree Diabetes Information System. Charts of eligible patients were audited for healthcare visits, glycemic control, blood pressure, lipid profile, pharmacological treatment and complications for the 2006 calendar year. Analyses were performed to assess the association of disease duration, age, target glycemic and blood pressure control with diabetes complications.
  
  
  RESULTS
  Half of the patients (49.7%) achieved target HbA1c, 53.6% had a blood pressure of ≤130/80 and 58.7% had an LDL of ≤2.5 mmol/L. The proportion of patients meeting all 3 targets was low at 17.1%. The mean number of diabetes-related clinic visits was high, with an average of 3.9 visits to a physician and an average of 8.7 visits to a registered nurse. Of patients with a documented diabetic complication, 39.4% of patients were not being managed with an ACE/ARB and 48.2% of patients were not prescribed a statin.
  
  
  CONCLUSIONS
  These findings suggest a possible treatment gap for risk factors and complications management. To circumvent further increases in diabetes-related complications, emphasis should be placed on improved healthcare worker training, greater use of clinical management and patient education tools and improved communication during the diabetes-related clinical visits. Development of a culturally appropriate multidisciplinary approach towards improved understanding of diabetes and multifactorial risk management for diabetic patients is essential for the prevention of diabetic complications.
authors.affiliation: Centre for Studies in Family Medicine, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Canada. mnaqshb2@uwo.ca
authors.forename: Mariam
authors.initials: M
authors.lastname: Naqshbandi Hayward
authors.forename: Elena
authors.initials: E
authors.lastname: Kuzmina
authors.forename: David
authors.initials: D
authors.lastname: Dannenbaum
authors.forename: Jill
authors.initials: J
authors.lastname: Torrie
authors.forename: Jennifer
authors.initials: J
authors.lastname: Huynh
authors.forename: Stewart
authors.initials: S
authors.lastname: Harris
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D054869:Clinical Audit; D003695:Delivery of Health Care / Q000458:organization & administration / Q000592:standards*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000628:therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007198:Indians, North American; D008297:Male; D008875:Middle Aged; D011792:Quebec; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D006442:Glycated Hemoglobin