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

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• 作者：Manoela F.B. Braga ; MD¹ ; Amparo Casanova ; MD PhD² ; Hwee Teoh ; PhD³ ; Keith G. Dawson ; MD PhD⁴ ; Hertzel C. Gerstein ; MD MSc⁵ ; David H. Fitchett ; MD² ; ⁶ ; Stewart B. Harris ; MD MPH⁷ ; George Honos ; MD⁸ ; ⁹ ; Philip A. McFarlane ; MD PhD¹⁰ ; Andrew Steele ; MD¹¹ ; Ehud Ur ; MB⁴ ; Jean-Franç ; ois Yale ; MD⁹ ; ¹² ; Anatoly Langer ; MD MSc² ; ⁶ ; Shaun G. Goodman ; MD MSc² ; ⁶ ; Lawrence A. Leiter ; MD¹³ ; ^{leiterl@smh.toronto.on.ca} ; on behalf of the Diabetes Registry to Improve Vascular Events (DRIVE) Investigators
• 关键词：Cardiovascular protection ; Clinical practice guidelines ; Diabetes ; Target achievement ; Treatment
• 刊名：Canadian Journal of Cardiology
• 出版年：2010
• 出版时间：June-July 2010
• 年：2010
• 卷：26
• 期：6
• 页码：297-302
• 全文大小：236 K

文摘

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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. Antiplatelet 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.