Glycated Hemoglobin Level Goal Achievement in Adults With Type 2 Diabetes in Canada: Still Room for Improvement

• Published in: Canadian journal of diabetes 2019-08, Vol.43 (6), p.384-391
• Main Authors: Leiter, Lawrence A., Cheng, Alice Y.Y., Ekoé, Jean-Marie, Goldenberg, Ronald M., Harris, Stewart B., Hramiak, Irene M., Khunti, Kamlesh, Lin, Peter J., Richard, Jean-François, Senior, Peter A., Yale, Jean-François, Goldin, Lianne, Tan, Mary K., Langer, Anatoly
• Format: Article
• Language: English
• Subjects: Adult; Biomarkers - analysis; Blood Glucose - analysis; Diabetes Mellitus, Type 2 - metabolism; Diabetes Mellitus, Type 2 - prevention & control; diabète de type 2; Disease Management; Female; Follow-Up Studies; Glycated Hemoglobin A - analysis; Humans; Hypoglycemic Agents - therapeutic use; inertie thérapeutique; Male; Medication Adherence - statistics & numerical data; Middle Aged; Needs Assessment; Patient Care - methods; Patient Care - standards; Physicians, Primary Care - standards; Practice Guidelines as Topic - standards; primary care; Prognosis; soins de santé primaires; specialist; Specialization - statistics & numerical data; spécialiste; Surveys and Questionnaires; therapeutic inertia; type 2 diabetes
• ISSN: 1499-2671; 2352-3840
• DOI: 10.1016/j.jcjd.2018.10.005

To describe the clinical histories and management of adults with type 2 diabetes who were not reaching their target glycated hemoglobin (A1C) levels and to identify barriers to achieving therapeutic goals. Practice assessment surveys and practice audits were completed by 88 primary care physicians (PCPs) in the Diabetes Mellitus Assessment of Clinical managemenT In ONtario (DM-ACTION) program and by 56 diabetes specialists in the Diabetes Mellitus IMproving PAtient Care in our communiTies (DM-IMPACT) program. The DM-ACTION audit analyzed data from 1,173 adults with A1C levels ≥7.3% who were not prescribed insulin; the DM-IMPACT audit included 135 individuals with similar characteristics. Most PCPs (92%) and specialists (88%) stated that they typically recommend A1C levels of ≤7.0%; more than 90% indicated that they adjusted antihyperglycemic therapy within 3 months if suboptimal A1C targets endured. Among the DM-ACTION patients, the median A1C level was 7.8%; the median time between the last 2 A1C tests was 5 months; 58% were taking ≤2 noninsulin antihyperglycemic agents; and adjustment of glucose-lowering therapy was noted for only 56%. The corresponding values for the DM-IMPACT patients were 8.0%, 4 months, 43% and 68%, respectively. PCPs and specialists attributed patients' factors and patients' adherence as primary causes of poor achievement of guideline-recommended targets. PCPs perceived patients' factors as the predominant barrier to optimizing care, but the specialists believed that therapeutic inertia stems from a wide range and a varied combination of patient-centric factors. Type 2 diabetes remains a health-care challenge in Canada and globally. Primary care physicians and specialists attributed patients' factors as principal obstacles to optimal diabetes management. However, physician-associated therapeutic inertia may also be an important barrier to unmet therapeutic goals. Décrire les antécédents cliniques et la prise en charge des adultes atteints du diabète de type 2 qui n'avaient pas atteint leurs valeurs cibles d'hémoglobine glyquée (A1c) et déterminer les obstacles à l'atteinte des objectifs thérapeutiques. Quatre-vingt-huit médecins en soins de santé primaires (MSSP) du programme DM-ACTION (Diabetes Mellitus Assessment of Clinical managemenT In ONtario) et 56 spécialistes du diabète du programme DM-IMPACT (Diabetes Mellitus IMproving PAtient Care in our communiTies) ont rempli les enquêtes d'évaluation des pratiques et les audits de pra