A comparison of the assessment and management of cardiometabolic risk in patients with and without type 2 diabetes mellitus in Canadian primary care
Article first published online: 11 JUN 2013
© 2013 John Wiley & Sons Ltd
Diabetes, Obesity and Metabolism
Volume 15, Issue 12, pages 1093–1100, December 2013
How to Cite
Teoh, H., Després, J.-P., Dufour, R., Fitchett, D. H., Goldin, L., Goodman, S. G., Harris, S. B., Langer, A., Lau, D. C. W., Lonn, E. M., Mancini, G. B. J., McFarlane, P. A., Poirier, P., Rabasa-Lhoret, R., Tan, M. K. and Leiter, L. A. (2013), A comparison of the assessment and management of cardiometabolic risk in patients with and without type 2 diabetes mellitus in Canadian primary care. Diabetes, Obesity and Metabolism, 15: 1093–1100. doi: 10.1111/dom.12134
- Issue published online: 5 NOV 2013
- Article first published online: 11 JUN 2013
- Accepted manuscript online: 17 MAY 2013 01:05PM EST
- Manuscript Accepted: 14 MAY 2013
- Manuscript Revised: 1 APR 2013
- Manuscript Received: 12 FEB 2013
- cardiometabolic risk;
- lifestyle changes;
- primary care
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.
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.
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.
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.