A comparison of the assessment and management of cardiometabolic risk in patients with and without type 2 diabetes mellitus in Canadian primary care

Authors

  • H. Teoh,

    1. Division of Endocrinology & Metabolism, Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
    2. Division of Cardiac Surgery, Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
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  • J.-P. Després,

    1. Department of Kinesiology, Université Laval, Québec City, Québec, Canada
    2. Department of Social and Preventive Medicine, Université Laval, Québec City, Québec, Canada
    3. Faculty of Medicine, Université Laval, Québec City, Québec, Canada
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  • R. Dufour,

    1. Clinique de Prévention Cardiovasculaire, Institut de Recherches Cliniques de Montréal, Université de Montréal, Montréal, Québec, Canada
    2. Department of Nutrition, Institut de Recherches Cliniques de Montréal, Université de Montréal, Montréal, Québec, Canada
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  • D. H. Fitchett,

    1. Division of Cardiology, Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
    2. Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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  • L. Goldin,

    1. Canadian Heart Research Centre, Toronto, Ontario, Canada
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  • S. G. Goodman,

    1. Division of Cardiology, Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
    2. Department of Medicine, University of Toronto, Toronto, Ontario, Canada
    3. Canadian Heart Research Centre, Toronto, Ontario, Canada
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  • S. B. Harris,

    1. Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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  • A. Langer,

    1. Division of Cardiology, Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
    2. Department of Medicine, University of Toronto, Toronto, Ontario, Canada
    3. Canadian Heart Research Centre, Toronto, Ontario, Canada
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  • D. C. W. Lau,

    1. Department of Medicine, University of Calgary, Calgary, Alberta, Canada
    2. Department of Biochemistry & Molecular Biology, University of Calgary, Calgary, Alberta, Canada
    3. Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada
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  • E. M. Lonn,

    1. Department of Medicine and Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, Ontario, Canada
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  • G. B. J. Mancini,

    1. Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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  • P. A. McFarlane,

    1. Department of Medicine, University of Toronto, Toronto, Ontario, Canada
    2. Division of Nephrology, Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
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  • P. Poirier,

    1. Faculty of Pharmacy, Université Laval, Québec City, Québec, Canada
    2. Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec City, Québec, Canada
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  • R. Rabasa-Lhoret,

    1. Department of Nutrition, Institut de Recherches Cliniques de Montréal, Université de Montréal, Montréal, Québec, Canada
    2. Platform of Research in Obesity, Diabetes and Metabolism, Institut de Recherches Cliniques de Montréal, Université de Montréal, Montréal, Québec, Canada
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  • M. K. Tan,

    1. Canadian Heart Research Centre, Toronto, Ontario, Canada
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  • L. A. Leiter

    Corresponding author
    1. Division of Endocrinology & Metabolism, Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
    2. Department of Medicine, University of Toronto, Toronto, Ontario, Canada
    3. Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
    • Correspondence to: Lawrence A. Leiter, St Michael's Hospital Medical Centre, 61 Queen Street East, Suite #6-121Q, Toronto, ON M5C 2T2, Canada.

      E-mail: leiterl@smh.ca

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Abstract

Aim

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.

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