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Comparative Study
. 2010 Jan;56(1):e13-9.

Attainment of Canadian Diabetes Association recommended targets in patients with type 2 diabetes: a study of primary care practices in St John's, Nfld

Farah McCrate  1 , Marshall Godwin, Laura Murphy
Affiliations
Comparative Study

Attainment of Canadian Diabetes Association recommended targets in patients with type 2 diabetes: a study of primary care practices in St John's, Nfld

Farah McCrate et al. Can Fam Physician. 2010 Jan.

Abstract
in English, French

Objective: To examine the degree to which targets for diabetes (blood pressure [BP], glycated hemoglobin [HbA1c], and low-density lipoprotein cholesterol [LDL-C]) are achieved in family practices and how these results compare with family physicians' perceptions of how well targets are being achieved.

Design: Chart audit and physician survey.

Setting: Newfoundland and Labrador.

Participants: Patients with type 2 diabetes and their family physicians.

Interventions: The charts of 20 patients with type 2 diabetes were randomly chosen from each of 8 family physician practices in St John's, Nfld, and data were abstracted. All family physicians in the province were surveyed using a modified Dillman method.

Main outcome measures: The most recent HbA1c, LDL-C, and BP measurements listed in each audited chart; surveyed family physicians' knowledge of the recommended targets for HbA1c, LDL-C, and BP and their estimates of what percentage of their patients were at those recommended targets.

Results: The chart audit revealed that 20.6% of patients were at the recommended target for BP, 48.1% were at the recommended target for HbA1c, and 17.5% were at the recommended target for LDL-C. When targets were examined collectively, only 2.5% of patients were achieving targets in all 3 areas. The survey found that most family physicians were aware of the recommended targets for BP, LDL-C, and HbA1c. However, their estimates of the percentages of patients in their practices achieving these targets appeared high (59.3% for BP, 58.2% for HbA1c, and 48.4% for LDL-C) compared with the results of the chart audit.

Conclusion: The findings of the chart audit are consistent with other published reports, which have illustrated that a large majority of patients with diabetes fall short of reaching recommended targets for BP, blood glucose, and lipid levels. Although family physicians are knowledgeable about recommended targets, there is a gap between knowledge and clinical outcomes. The reasons for this are likely multifactorial. Further investigation is needed to better understand this phenomenon as well as to understand the foundation for physicians' optimistic estimates of how many of their patients with diabetes were reaching target values.

OBJECTIF: Établir à quel point les cibles pour le diabète (tension artérielle [TA], hémoglobine glycosylée [HbA1c] et cholestérol des lipoprotéines de basse densité [LDL-C]) sont atteintes en pratique familiale et comment ces résultats se comparent aux perceptions des médecins de famille concernant l’atteinte de ces cibles.

TYPE D’ÉTUDE: Revue de dossiers et enquête auprès de médecins.

CONTEXTE: Terre-Neuve et Labrador.

PARTICIPANTS: Diabétiques de type 2 et leurs médecins de famille.

INTERVENTIONS: On a choisi au hasard les dossiers de 20 diabétiques de type 2 dans les bureaux de 8 médecins de famille de St-Jean, TN, pour en extraite les données pertinentes. Par ailleurs, tous les médecins de la province ont fait l’objet d’une enquête par une méthode de Dillman modifiée.

PRINCIPAUX PARAMÈTRES ÉTUDIÉS: Les plus récentes valeurs de HbA1c, LDL-C et de TA inscrites dans chaque dossier révisé; connaissances des médecins de famille sondés sur les valeurs cibles recommandées pour ces paramètres et leur estimation du pourcentage de leurs patients qui atteignent les cibles recommandées.

RÉSULTATS: La révision des dossiers a révélé que le pourcentage des patients qui atteignaient les cibles recommandées était de 20,6 % pour la TA, de 48,1 % pour l’HbA1c et de 17,5 % pour le HDL-C. Seulement 2,5 % des patients avaient atteint les cibles pour les 3 paramètres. L’enquête a montré que la plupart des médecins de famille connaissaient les cibles recommandées pour les 3 paramètres. Toutefois, leur estimation du pourcentage des patients de leur clientèle ayant atteint ces cibles était plutôt élevée (59,3 % pour la TA, 58,2 % pour l’HbA1c et 48,4 % pour le HDL-C) par rapport aux résultats de la révision des dossiers.

CONCLUSION: Les observations de la révision des dossiers confirment des études antérieures qui ont montré qu’une très vaste majorité de diabétiques n’atteignent pas les cibles recommandées pour la TA, la glycémie et les niveaux de lipides. Même si les médecins connaissent bien ces cibles, il existe un écart entre connaissances et réalité clinique. Plusieurs facteurs sont sans doute responsables de cela. Il faudra d’autres études pour mieux cerner ce phénomène et pour comprendre l’origine des estimations optimistes des médecins quant au pourcentage de leurs patients qui atteignent les valeurs cibles.

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