Type 2 diabetes mellitus management in Canada: is it improving?
OBJECTIVE
To gain insight into the current management of patients with type 2 diabetes mellitus by Canadian primary care physicians.


METHODS
A total of 479 primary care physicians from across Canada submitted data on 5123 type 2 diabetes patients whom they had seen on a single day on or around World Diabetes Day, November 14, 2012.


RESULTS
Mean glycated hemoglobin (A1C) was 7.4%, low-density lipoprotein (LDL-C) was 2.1 mmol/L and blood pressure (BP) was 128/75 mm Hg. A1C ≤7.0% was met by 50%, LDL-C ≤2.0 mmol/L by 57%, BP <130/80 mm Hg by 36% and the composite triple target by 13% of patients. Diet counselling had been offered to 38% of patients. Of the 87% prescribed antihyperglycemic agents, 18% were on 1 non-insulin antihyperglycemic agent (NIAHA) (85% of which was metformin), 15% were on 2 NIAHAs, 6% were on ≥3 NIAHAs, 19% were on insulin only and 42% were on insulin + ≥1 NIAHA(s). Amongst the 81% prescribed lipid-lowering therapy, 88% were on monotherapy (97% of which was a statin). Among the 83% prescribed antihypertensive agents, 39%, 34%, 21% and 6% received 1, 2, 3 and >3 drugs, respectively, with 59% prescribed angiotensin-converting enzyme inhibitors and 35% angiotensin II receptor blockers.


CONCLUSIONS
The Diabetes Mellitus Status in Canada survey highlights the persistent treatment gap associated with the treatment of type 2 diabetes and the challenges faced by primary care physicians to gain glycemic control and global vascular protection in these patients. It also reveals a higher use of insulin therapy in primary care practices relative to previous surveys. Practical strategies aimed at more effectively managing type 2 diabetes patients are urgently needed.
Division of Endocrinology and Metabolism, Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada. Electronic address: leiterl@smh.ca.
Lawrence A
LA
Leiter
Lori
L
Berard
C Keith
CK
Bowering
Alice Y
AY
Cheng
Keith G
KG
Dawson
Jean-Marie
JM
Ekoé
Carl
C
Fournier
Lianne
L
Goldin
Stewart B
SB
Harris
Peter
P
Lin
Thomas
T
Ransom
Mary
M
Tan
Hwee
H
Teoh
Ross T
RT
Tsuyuki
Dana
D
Whitham
Vincent
V
Woo
Jean-François
JF
Yale
Anatoly
A
Langer
D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D001794:Blood Pressure; D002170:Canada / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy* / Q000453:epidemiology* / Q000503:physiopathology; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D008077:Lipoproteins, LDL / Q000097:blood; D008297:Male; D008875:Middle Aged; D010820:Physicians; D017410:Practice Guidelines as Topic
D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D008077:Lipoproteins, LDL; C517652:hemoglobin A1c protein, human
blood pressure; care gap; diabète de type 2; glycemic control; guidelines; lacunes en matière de soins; lignes directrices; lipides; lipids; management; maîtrise de la glycémie; pression artérielle; prise en charge; type 2 diabetes