Adherence to Canadian Diabetes Association Clinical Practice Guidelines: RESULTS

29 Nov

Of the 349 patients with type 2 diabetes who first visited the Diabetes Education Centre in 2004, 167 (48%) met the inclusion criteria. The other patients were excluded because they did not meet age criteria (140 [40%]), they did not attend a formal Session 1 class (40 [11%]), or they died (causes of death unknown) (2 [<1%]). Patients’ data were available for a median period of 120 days (range 1-645 days) from their first visit to the Diabetes Education Centre.

Selected baseline characteristics are displayed in Table 3. Of the 167 patients, 104 (62%) were men; their mean age was 53 years, and at the time of first visit to the Diabetes Education Centre, the mean time since diagnosis was 54 days. At baseline, 30/166 (18%) patients were current smokers, 90/100 (90%) had metabolic syndrome, and the mean body mass index was 32 kg/m2. Mean fasting plasma glucose, blood pressure, and LDL cholesterol were all above CDA targets.

The first set of outcomes related to achievement of recommended monitoring frequencies. One hundred and fifty-five (93%) of the 167 patients had their hemoglobin A1C monitored at least once within the first 3 months. The proportion decreased to 104/167 (62%) who had their hemoglobin Аю monitored at least 2 times within the first 6 months and to only 4/89 (4%) who had hemoglobin Аю monitored at least 6 times within the first 18 months. Lipids were measured at baseline in 136 (81%) of the 167 patients. The urinary albumin to creatinine ratio was measured at baseline for 106/167 (63%) patients and within the year after baseline for 71/151 (47%) patients. An eye examination was performed at baseline for 95/119 (80%) patients and within the 2 years after baseline for 25/40 (63%) patients.
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The second set of outcomes related to achievement of recommended laboratory targets. Fasting plasma glucose of 4-7 mmol/L was achieved within 3 months for 51 (44%) of 115 patients, and hemoglobin AK below 7% was achieved within 12 months for 108 (93%) of 116 patients. Blood pressure targets (systolic < 130 mm Hg and diastolic < 80 mm Hg) were achieved for 35 (21%) of 164 patients at the most recent measure­ment. The most recent LDL cholesterol value was below 2.5 mmol/L in 50 (33%) of 151 patients, and the most recent ratio of total cholesterol to HDL cholesterol was below 4.0 in 54 (34%) of 160 patients.

The final set of outcomes related to receipt of recommended medications by eligible patients. Of the 64 patients with a fasting plasma glucose above 7 mmol/L within 3 months, 36 (56%) received an antihyperglycemic agent. Of the 149 patients with blood pressure of at least 130/80 mm Hg at any time, 67 (45%) received an antihypertensive agent. Of the 117 patients with a LDL cholesterol of at least 2.5 mmol/L at any time, 29 (25%) received a statin. Of the 61 patients with a Framingham 10-year risk score of 10% or greater at any time, 16 (26%) received acetylsalicylic acid. canadian discount pharmacy