Treatment gaps in the management of cardiovascular risk factors in patients with type 2 diabetes in Canada

被引:66
作者
Braga, Manoela F. B.
Casanova, Amparo
Teoh, Hwee [1 ]
Dawson, Keith G. [2 ]
Gerstein, Hertzel C. [3 ,4 ]
Fitchett, David H. [5 ]
Harris, Stewart B. [6 ,7 ,8 ]
Honos, George [9 ,10 ]
McFarlane, Philip A. [11 ]
Steele, Andrew [12 ]
Ur, Ehud [2 ]
Yale, Jean-Francois [13 ]
Langer, Anatoly [5 ]
Goodman, Shaun G. [5 ]
Leiter, Lawrence A. [14 ]
机构
[1] Univ Toronto, St Michaels Hosp, Keenan Res Ctr, Li Ka Shing Knowledge Inst,Div Cardiac Surg, Toronto, ON M5B 1W8, Canada
[2] Univ British Columbia, Div Endocrinol & Metab, Vancouver, BC V5Z 1M9, Canada
[3] McMaster Univ, Dept Clin Epidemiol, Hamilton, ON L8S 4L8, Canada
[4] McMaster Univ, Dept Biostat, Hamilton, ON L8S 4L8, Canada
[5] Univ Toronto, St Michaels Hosp, Li Ka Shing Knowledge Inst, Div Cardiol,Keenan Res Ctr, Toronto, ON M5B 1W8, Canada
[6] Univ Western Ontario, Schulich Sch Med & Dent, Dept Family Med, London, ON, Canada
[7] Univ Western Ontario, Schulich Sch Med & Dent, Dept Epidemiol & Biostat, London, ON, Canada
[8] Univ Western Ontario, Schulich Sch Med & Dent, Dept Med, London, ON, Canada
[9] Sir Mortimer B Davis Jewish Hosp, Davis, CA USA
[10] McGill Univ, Dept Med, Montreal, PQ, Canada
[11] Univ Toronto, St Michaels Hosp, Li Ka Shing Knowledge Inst, Div Nephrol,Keenan Res Ctr, Toronto, ON M5B 1W8, Canada
[12] Lakeridge Hlth Corp, Oshawa, ON, Canada
[13] Royal Victoria Hosp, McGill Nutr & Food Sci Ctr, Montreal, PQ H3A 1A1, Canada
[14] Univ Toronto, St Michaels Hosp, Li Ka Shing Knowledge Inst, Div Endocrinol & Metab,Keenan Res Ctr, Toronto, ON M5B 1W8, Canada
关键词
Cardiovascular protection; Clinical practice guidelines; Diabetes; Target achievement; Treatment; GLYCEMIC CONTROL; MULTIFACTORIAL INTERVENTION; DISEASE; MORTALITY; PERINDOPRIL; MORBIDITY; MELLITUS;
D O I
10.1016/S0828-282X(10)70393-7
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
OBJECTIVES: To evaluate vascular protection treatment patterns and attainment of the 2003 Canadian Diabetes Association's recommended targets in ambulatory patients with type 2 diabetes. METHODS: Between 2005 and 2006, 3002 outpatients with type 2 diabetes were enrolled by 229 primary health care settings across Canada. Baseline characteristics, therapeutic regimens and treatment success defined as the achievement of a blood pressure (BP) of 130/80 mmHg or lower, glycosylated hemoglobin (A1C) of 7% or lower, low-density lipoprotein cholesterol (LDL-C) lower than 2.5 mmol/L and total cholesterol/high-density lipoprotein cholesterol ratio lower than 4.0 - are reported. RESULTS: Overall, 46% of individuals had a BP that was above the Canadian Diabetes Association's recommended target. Of these, 11% were untreated, 28% were receiving monotherapy, 38% were not receiving an angiotensin-converting enzyme inhibitor and 16% were not receiving either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Optimal A1C levels were achieved in 53% of patients. Of those who did not attain A1C targets, 3% were not on glucose-lowering pharmacotherapy and 27% were receiving monotherapy. A total of 74% of patients were treated with statins. Overall, 64% and 62%, respectively, met the target LDL-C and the target total cholesterol/high-density lipoprotein cholesterol ratio. Statins were not prescribed to 43% of patients with LDL-C above target. Antiplateler therapy was implemented in 81% of patients. In total, 21% achieved the combined targets for BP, A1C and LDL-C. INTERPRETATION: A substantial proportion of patients did not achieve guideline-recommended targets and were not receiving evidence-based therapy for vascular protection two years after publication of the Canadian guidelines. More research is warranted, and novel and effective strategies must be tested and implemented to correct this ongoing treatment gap.
引用
收藏
页码:297 / 302
页数:6
相关论文
共 21 条
[11]   Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction [J].
Haffner, SM ;
Lehto, S ;
Rönnemaa, T ;
Pyörälä, K ;
Laakso, M .
NEW ENGLAND JOURNAL OF MEDICINE, 1998, 339 (04) :229-234
[12]   Glycemic control and morbidity in the Canadian primary care setting (results of the diabetes in Canada evaluation study) [J].
Harris, SB ;
Ekoé, JM ;
Zdanowicz, Y ;
Webster-Bogaert, S .
DIABETES RESEARCH AND CLINICAL PRACTICE, 2005, 70 (01) :90-97
[13]   Is glycemic control improving in US adults? [J].
Hoerger, Thomas J. ;
Gregg, Edward W. ;
Segel, Joel E. ;
Saaddine, Jinan B. .
DIABETES CARE, 2008, 31 (01) :81-86
[14]  
Leiter L.A., 2006, CAN J DIABETES, V30, P230
[15]  
LEITER LA, 2006, BR J DIABETES VASC D, V6, P31
[16]   Control of cardiovascular risk factors in patients with diabetes and hypertension at urban academic medical centers [J].
McFarlane, SI ;
Jacober, SJ ;
Winer, N ;
Kaur, J ;
Castro, JP ;
Wui, MA ;
Gliwa, A ;
Von Gizycki, H ;
Sowers, JR .
DIABETES CARE, 2002, 25 (04) :718-723
[17]  
Rydén L, 2007, EUR HEART J, V28, P88, DOI [10.1093/eurheartj/ehl260, 10.1093/eurheartj/ehm124]
[18]   Poor control of risk factors for vascular disease among adults with previously diagnosed diabetes [J].
Saydah, SH ;
Fradkin, J ;
Cowie, CC .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2004, 291 (03) :335-342
[19]  
Stearne MR, 1998, BMJ-BRIT MED J, V317, P703
[20]   Glycemic control with diet, sulfonylurea, metformin, or insulin in patients with type 2 diabetes mellitus - Progressive requirement for multiple therapies (UKPDS 49) [J].
Turner, RC ;
Cull, CA ;
Frighi, V ;
Holman, RR .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1999, 281 (21) :2005-2012