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. 2023 Jan 9;195(1):E1-E9.
doi: 10.1503/cmaj.220673.

Achievement of treatment targets among patients with type 2 diabetes in 2015 and 2020 in Canadian primary care

Shiva Nandiwada  1 , Donna P Manca  1 , Roseanne O Yeung  1 , Darren Lau  2
Affiliations

Achievement of treatment targets among patients with type 2 diabetes in 2015 and 2020 in Canadian primary care

Shiva Nandiwada et al. CMAJ. .

Abstract

Background: An update on the degree to which patients with type 2 diabetes in Canada achieve treatment targets is needed to document progress and identify subgroups that need attention. We sought to estimate the frequency with which patients managed in primary care met treatment targets (i.e., HbA1c ≤ 7.0%, blood pressure < 130/80 mm Hg and low-density lipoprotein cholesterol [LDL-C] < 2.00 mmol/L), guideline-based use of statins and of angiotensin-convertingenzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs), and the effects of patient age and sex.

Methods: We conducted a cross-sectional study of 32 503 and 44 930 adults with diabetes in Canada on June 30, 2015, and 2020, respectively, using electronic medical record data from primary care practices across 5 provinces. We grouped achievement of diabetes targets by age and sex, and compared between groups using logistic regression with adjustment for cardiovascular comorbidities.

Results: In 2020, target HbA1c levels were achieved for 63.8% of women and 58.9% of men. Blood pressure and LDL-C targets were achieved for 45.6% and 45.8% of women, and for 43.1% and 59.4% of men, respectively. All 3 treatment targets were achieved for 13.3% of women and 16.5% of men. Overall, 45.3% and 54.0% of women and men, respectively, used statins; 46.5% of women used ACE inhibitors or ARBs, compared with 51.9% of men. With the exception of blood pressure and HbA1c levels among women, target achievement was lower among younger patients. Achievement of the LDL-C target, statin use and ACE inhibitor or ARB use were lower among women at any age. From 2015 to 2020, target achievement increased for HbA1c, remained consistent for LDL-C and declined for blood pressure; use of statins and of ACE inhibitors or ARBs also declined.

Interpretation: Target achievement for blood pressure and use of statins and of ACE inhibitors and ARBs declined between 2015 and 2020, and was suboptimal in all patient groups. Widespread quality improvement is needed to increase evidence-based therapy for people with diabetes.

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Conflict of interest statement

Competing interests: Rose Yeung has received research funding from Novo Nordisk Alberta Diabetes Fund (University Hospital Foundation, Novo Nordisk and Alberta Economic Development and Trade). Rose Yeung is medical director of the University of Alberta Office of Lifelong Learning and Physician Learning Program; the Physician Learning Program is funded by the Government of Alberta. Darren Lau reports payment from the Alberta College of Family Physicians. No other competing interests were declared.

Figures

Figure 1:
Figure 1:
Study flowchart of individuals with diabetes in 2020. See Appendix 1, Figure S1, available at www.cmaj.ca/lookup/doi/10.1503/cmaj.220673/tab-related-content for the 2015 study flowchart.
Figure 2:
Figure 2:
Diabetes target achievement for (A) glycated hemoglobin (HbA1c), (B) systolic (SBP) and diastolic (DBP) blood pressure, (C) low-density lipoprotein cholesterol (LDL-C) and (D) all 3 targets, as well as use of (E) statins and of (F) angiotensin-converting-enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) in men and women of different age groups.
See this image and copyright information in PMC

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