Glycaemic control and cardiovascular risk factor management in patients with diabetes with and without coronary artery disease: insights from the diabetes mellitus status in Canada survey

Jasmine Grenier, Lawrence A. Leiter, Anatoly Langer, Lianne Goldin, Hwee Teoh, Kim A. Connelly, Alice Y.Y. Cheng, Mary K. Tan, David Fitchett, Darren K McGuire, Shaun G. Goodman, Andrew T. Yan

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Aims: Current diabetes guidelines recommend an individualized approach to glycaemic control. There are limited data on the contemporary and comprehensive management of patients with diabetes in relation to coronary artery disease (CAD).

Methods and results: The Diabetes Mellitus Status in Canada (DM-SCAN) survey included 5123 patients with type 2 diabetes seen in primary care in November 2012. Primary care physicians (PCPs) collected clinical data and specified the A1C target for each patient on standardized forms. We compared management strategies and achievement of treatment targets in patients with and without CAD. Among the 4994 patients with data on CAD history, 22.5% had CAD. Primary care physicians were more likely to select a higher A1C target for patients with CAD (≤7.5 or ≤8.0%) versus without (≤7.0%). There was no difference in median A1C or in the proportion of patients with A1C ≤7.0% between the two groups. Compared with the group without known CAD, patients with CAD had a higher reported prevalence of hypoglycaemia in the preceding 6 months; more frequently received aspirin, statins, ACE inhibitors, or angiotensin receptor blockers, and were more likely to achieve blood pressure and low-density lipoprotein-cholesterol targets. Only 15.4 and 12.0% of patients with and without CAD (P = 0.002), respectively, achieved all three guideline-recommended targets.

Conclusion: Compared with patients with diabetes without CAD, those with CAD more frequently had a less stringent A1C target selected by their PCPs but achieved similar glycaemic control. Overall, risk factor management remained suboptimal in both groups. There remains an important opportunity to improve the care and outcome of patients with diabetes.

Original languageEnglish (US)
Pages (from-to)277-284
Number of pages8
JournalEuropean heart journal. Quality of care & clinical outcomes
Volume2
Issue number4
DOIs
StatePublished - Oct 1 2016

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Risk Management
Canada
Coronary Artery Disease
Diabetes Mellitus
Primary Care Physicians
Surveys and Questionnaires
Guidelines
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Angiotensin Receptor Antagonists
Hypoglycemia
Angiotensin-Converting Enzyme Inhibitors
LDL Cholesterol
Type 2 Diabetes Mellitus
Aspirin
Primary Health Care
Patient Care
Blood Pressure

ASJC Scopus subject areas

  • Medicine(all)

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Glycaemic control and cardiovascular risk factor management in patients with diabetes with and without coronary artery disease : insights from the diabetes mellitus status in Canada survey. / Grenier, Jasmine; Leiter, Lawrence A.; Langer, Anatoly; Goldin, Lianne; Teoh, Hwee; Connelly, Kim A.; Cheng, Alice Y.Y.; Tan, Mary K.; Fitchett, David; McGuire, Darren K; Goodman, Shaun G.; Yan, Andrew T.

In: European heart journal. Quality of care & clinical outcomes, Vol. 2, No. 4, 01.10.2016, p. 277-284.

Research output: Contribution to journalArticle

Grenier, Jasmine ; Leiter, Lawrence A. ; Langer, Anatoly ; Goldin, Lianne ; Teoh, Hwee ; Connelly, Kim A. ; Cheng, Alice Y.Y. ; Tan, Mary K. ; Fitchett, David ; McGuire, Darren K ; Goodman, Shaun G. ; Yan, Andrew T. / Glycaemic control and cardiovascular risk factor management in patients with diabetes with and without coronary artery disease : insights from the diabetes mellitus status in Canada survey. In: European heart journal. Quality of care & clinical outcomes. 2016 ; Vol. 2, No. 4. pp. 277-284.
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AU - Leiter, Lawrence A.

AU - Langer, Anatoly

AU - Goldin, Lianne

AU - Teoh, Hwee

AU - Connelly, Kim A.

AU - Cheng, Alice Y.Y.

AU - Tan, Mary K.

AU - Fitchett, David

AU - McGuire, Darren K

AU - Goodman, Shaun G.

AU - Yan, Andrew T.

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N2 - Aims: Current diabetes guidelines recommend an individualized approach to glycaemic control. There are limited data on the contemporary and comprehensive management of patients with diabetes in relation to coronary artery disease (CAD).Methods and results: The Diabetes Mellitus Status in Canada (DM-SCAN) survey included 5123 patients with type 2 diabetes seen in primary care in November 2012. Primary care physicians (PCPs) collected clinical data and specified the A1C target for each patient on standardized forms. We compared management strategies and achievement of treatment targets in patients with and without CAD. Among the 4994 patients with data on CAD history, 22.5% had CAD. Primary care physicians were more likely to select a higher A1C target for patients with CAD (≤7.5 or ≤8.0%) versus without (≤7.0%). There was no difference in median A1C or in the proportion of patients with A1C ≤7.0% between the two groups. Compared with the group without known CAD, patients with CAD had a higher reported prevalence of hypoglycaemia in the preceding 6 months; more frequently received aspirin, statins, ACE inhibitors, or angiotensin receptor blockers, and were more likely to achieve blood pressure and low-density lipoprotein-cholesterol targets. Only 15.4 and 12.0% of patients with and without CAD (P = 0.002), respectively, achieved all three guideline-recommended targets.Conclusion: Compared with patients with diabetes without CAD, those with CAD more frequently had a less stringent A1C target selected by their PCPs but achieved similar glycaemic control. Overall, risk factor management remained suboptimal in both groups. There remains an important opportunity to improve the care and outcome of patients with diabetes.

AB - Aims: Current diabetes guidelines recommend an individualized approach to glycaemic control. There are limited data on the contemporary and comprehensive management of patients with diabetes in relation to coronary artery disease (CAD).Methods and results: The Diabetes Mellitus Status in Canada (DM-SCAN) survey included 5123 patients with type 2 diabetes seen in primary care in November 2012. Primary care physicians (PCPs) collected clinical data and specified the A1C target for each patient on standardized forms. We compared management strategies and achievement of treatment targets in patients with and without CAD. Among the 4994 patients with data on CAD history, 22.5% had CAD. Primary care physicians were more likely to select a higher A1C target for patients with CAD (≤7.5 or ≤8.0%) versus without (≤7.0%). There was no difference in median A1C or in the proportion of patients with A1C ≤7.0% between the two groups. Compared with the group without known CAD, patients with CAD had a higher reported prevalence of hypoglycaemia in the preceding 6 months; more frequently received aspirin, statins, ACE inhibitors, or angiotensin receptor blockers, and were more likely to achieve blood pressure and low-density lipoprotein-cholesterol targets. Only 15.4 and 12.0% of patients with and without CAD (P = 0.002), respectively, achieved all three guideline-recommended targets.Conclusion: Compared with patients with diabetes without CAD, those with CAD more frequently had a less stringent A1C target selected by their PCPs but achieved similar glycaemic control. Overall, risk factor management remained suboptimal in both groups. There remains an important opportunity to improve the care and outcome of patients with diabetes.

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