title: A comparison of the assessment and management of cardiometabolic risk in patients with and without type 2 diabetes mellitus in Canadian primary care.
abstract: OBJECTIVE
  To investigate the cardiometabolic risk (CMR) assessment and management patterns for individuals with and without type 2 diabetes mellitus (T2DM) in Canadian primary care practices.
  
  
  METHODS
  Between April 2011 and March 2012, physicians from 9 primary care teams and 88 traditional non-team practices completed a practice assessment on the management of 2461 patients >40 years old with no clinical evidence of cardiovascular disease and diagnosed with at least one of the following risk factor-T2DM, dyslipidaemia or hypertension.
  
  
  RESULTS
  There were 1304 individuals with T2DM and 1157 without. Pharmacotherapy to manage hyperglycaemia, dyslipidaemia and hypertension was widely prescribed. Fifty-eight percent of individuals with T2DM had a glycated haemoglobin (HbA1c) ≤7.0%. Amongst individuals with dyslipidaemia, median low-density lipoprotein cholesterol (LDL-C) was 1.8 mmol/l for those with T2DM and 2.8 mmol/l for those without. Amongst individuals with hypertension, 30% of those with T2DM achieved the <130/80 mmHg target, whereas 60% of those without met the <140/90 mmHg target. The composite glycaemic, LDL-C and blood pressure (BP) target outcome was achieved by 12% of individuals with T2DM. Only 17% of individuals with T2DM and 11% without were advised to increase their physical activity. Dietary modifications were recommended to 32 and 10% of those with and without T2DM, respectively.
  
  
  CONCLUSIONS
  Patients at elevated CMR were suboptimally managed in the primary care practices surveyed. There was low attainment of recommended therapeutic glycaemic, lipid and BP targets. Advice on healthy lifestyle changes was infrequently dispensed, representing a missed opportunity to educate patients on the long-term benefits of lifestyle modification.
authors.affiliation: Division of Endocrinology & Metabolism, Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada; Division of Cardiac Surgery, Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: H
authors.initials: H
authors.lastname: Teoh
authors.forename: J-P
authors.initials: JP
authors.lastname: Després
authors.forename: R
authors.initials: R
authors.lastname: Dufour
authors.forename: D H
authors.initials: DH
authors.lastname: Fitchett
authors.forename: L
authors.initials: L
authors.lastname: Goldin
authors.forename: S G
authors.initials: SG
authors.lastname: Goodman
authors.forename: S B
authors.initials: SB
authors.lastname: Harris
authors.forename: A
authors.initials: A
authors.lastname: Langer
authors.forename: D C W
authors.initials: DC
authors.lastname: Lau
authors.forename: E M
authors.initials: EM
authors.lastname: Lonn
authors.forename: G B J
authors.initials: GB
authors.lastname: Mancini
authors.forename: P A
authors.initials: PA
authors.lastname: McFarlane
authors.forename: P
authors.initials: P
authors.lastname: Poirier
authors.forename: R
authors.initials: R
authors.lastname: Rabasa-Lhoret
authors.forename: M K
authors.initials: MK
authors.lastname: Tan
authors.forename: L A
authors.initials: LA
authors.lastname: Leiter
mesh_terms: D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001955:British Columbia; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000188:drug therapy; D050171:Dyslipidemias / Q000150:complications / Q000188:drug therapy*; D005081:Exercise Therapy / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000150:complications / Q000188:drug therapy*; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009864:Ontario; D011320:Primary Health Care / Q000706:statistics & numerical data; D011792:Quebec; D040242:Risk Reduction Behavior
chemical_list: D000959:Antihypertensive Agents; D007004:Hypoglycemic Agents; D000960:Hypolipidemic Agents
keywords: cardiometabolic risk; lifestyle changes; pharmacotherapy; primary care