Diabetes Management in Canada: Baseline Results of the Group Practice Diabetes Management Study

ABSTRACTBACKGROUNDThere exists a considerable gap between best practice as rec-ommended by diabetes guidelines and actual practice. The objective of this study was to determine the level of care being provided to patients with type 2 diabetes by family physicians in group practices in 4 regions of Canada.METHODSBaseline characteristics from a cluster-randomized trial using chart audits were recorded to assess glycemic control and rates of physician adherence to guidelines-recommended practice. Intracluster correlation coefficients (ICCs) were calculated using the physician practice as the cluster.RESULTSFifty-six physicians in 16 group practices provided 549 charts. Glycosylated hemoglobin (A1C) was measured in 71.8% of patients (mean: 7.7%). A total of 82.3% received antihyperglycemic medication, but only 35.3% achieved an A1C < 7.0%. Blood pressure (BP) results were documented in 92.7% of charts (mean: 139/79 mm Hg).While 58.1% of patients received antihypertensive medications, only 20.0% had BP < 130/85 mm Hg. Lipid profiles were documented in 62.3% of patients. The percentage of patients achieving lipid targets was 83.9% for low-density lipoprotein cholesterol, 38.3% for triglycerides and 76.2% for total cholesterol:high-density lipoprotein cholesterol ratio. Lipid-lowering agents and ASA were prescribed for 19.7% and 22.4% of patients, respectively. Only 17.5% of patients had a 24-hour urine/ albumin-creatinine ratio, 32.1% had a dilated eye exam, 20.0% had a peripheral neuropathy exam and 25.9% had a foot exam. Patient outcome ICCs ranged from 0 to 0.14, while physician process ICCs ranged from 0 to 0.57.INTERPRETATIONDespite high rates of screening for glycemia and macrovascu-lar complications, treatment was not sufficiently intensive for most patients. Family physicians performed poorly in microvascular complication screening.

RÉSUMÉOBJECTIFPLAN ET MÉTHODESRÉSULTATSCONCLUSIONS