Glycemic control and morbidity in the Canadian primary care setting (results of the diabetes in Canada evaluation study)

https://doi.org/10.1016/j.diabres.2005.03.024Get rights and content

Abstract

The objective of this national, cross-sectional study was to provide insight into the care and treatment of type 2 diabetes (T2DM) in the Canadian primary care setting. Specifically, the study examines glycemic control, management and morbidity load among T2DM patients, and investigates the relationship of glycemic control and morbidity load with duration of diabetes. Participating primary care physicians (PCPs) (N = 243) completed a chart audit for the first 10 patients with T2DM attending their clinics (2473 eligible patient records). The mean A1C was 7.3% with 49% of patients not at target (A1C  7.0%). Glycemic control eroded significantly with increasing duration of diabetes in spite of increasing therapeutic intervention. T2DM patients experienced a high morbidity load (hypertension 63%; dyslipidemia 59%; macrovascular complications 28%; microvascular complications 38%) each of which increased significantly with duration of diabetes. For 79% of patients not at target, PCPs identified lifestyle intervention as the strategy for achieving glycemic targets while more aggressive treatment plans were identified for only 56%. These results underscore the complexity of primary care management of T2DM and suggest that current treatment approaches are not intensive enough for a large proportion of patients especially those with longer duration of disease.

Section snippets

Research design and methods

A cross-sectional chart audit methodology was employed. The Canadian Medical Association publishes a comprehensive database [13] on an annual basis. At the time of this study, the database contained 26,174 PCPs. Physicians who had requested not to be contacted for research were excluded, resulting in a list of 20,423 PCPs. In order to obtain a final target sample of 300 PCPs and estimating a minimal response rate of 10%, 3000 PCPs were randomly selected from this list and sent recruitment

Results

Participating PCPs had been in practice for a mean 17.5 years. Seventy-nine percent of PCPs were male and 15% worked in rural practices. Fifty-six percent of PCPs worked in group practice, 73% were affiliated with a hospital and 81% of PCPs reported that they had attended a continuing education event on T2DM in the past year.

The mean patient age at review was 62.7 years, 54% were male, and the mean body mass index (BMI) was 31 kg/m2. The dominant drug insurance coverage was provincial formulary

Conclusions

This large, national, cross-sectional study depicts the disease burden associated with T2DM in the primary care setting in Canada. Further, it is one of the few to provide an evaluation of T2DM by duration of disease. Findings suggest that a considerable proportion of T2DM patients in Canada are not well controlled and that disease burden is quite high.

There are few published, national, studies assessing glycemic control within the family practice setting. The mean A1C (7.3%) and the percentage

Acknowledgements

This study was funded by GlaxoSmithKline. Special thanks to Lisa Mullett from GlaxoSmithKline for her input throughout the study and to Dr. Edward Adlaf from the Centre for Addiction and Mental Health for his consul regarding the analyses. As well, the authors would like to thank all the physicians for their participation. Stewart B. Harris is a Career Scientist of the Ontario Ministry of Health and Long Term Care.

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