Aims

Our objective was to examine risk factor modification targets and treatment in relation to duration of diabetes.

Methods

The Diabetes Mellitus Status in Canada (DM-SCAN) study collected data on 5109 patients with type 2 diabetes mellitus (T2DM) in 2012 in primary care. We compared the prevalence of vascular complications, treatment targets, and interventions between patients with diagnosed diabetes duration ≤10 and > 10 years.

Results

Physicians more frequently assigned HbA1c (glycated hemoglobin) targets of 7.1–8.5% (54–69 mmol/mol) to patients with longer duration of diabetes (n = 1647) (19.8% vs 9.5%, p < 0.001). Patients with longer duration of diabetes were less likely to achieve HbA1c targets of ≤7.0% (53 mmol/mol) (39% vs. 55%, p < 0.001), had similar likelihood of achieving blood pressure targets of ≤130/80 mmHg (38% vs. 36%, p = 0.26) and were more likely to achieve LDL-C targets of ≤2.0 mmol/L (≤77.3 mg/dL) (63% vs. 53%, p < 0.001) compared to patients with shorter duration of diabetes (n = 3462). Achievement of all three targets between both groups were similar (13% vs. 13%, p = 0.82). Overall, patients with longer duration of diabetes were more likely to be prescribed anti-hyperglycemic, anti-hypertensive, lipid-lowering medications and referred for diabetes education.

Conclusions

Only 13% of patients achieved glycemic, blood pressure, and LDL-C targets irrespective of duration of diabetes. Despite being managed with more medications, patients with longer duration of diabetes were less likely to achieve glycemic targets. More focus is needed on developing methods to bridge best care and real-world practice.

中文翻译：

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糖尿病患者的心血管危险因素管理：管理是否因病程而异？

目标

我们的目标是检查与糖尿病病程相关的风险因素修正目标和治疗。

方法

加拿大糖尿病状况 (DM-SCAN) 研究收集了 2012 年初级保健中 5109 名 2 型糖尿病 (T2DM) 患者的数据。我们比较了诊断为糖尿病病程≤10 年和 > 10 年的患者之间血管并发症的发生率、治疗目标和干预措施。

结果

医生更频繁地将 7.1-8.5% (54-69 mmol/mol) 的 HbA1c（糖化血红蛋白）目标分配给糖尿病病程较长的患者（n  = 1647）（19.8% 对 9.5%，p  < 0.001）。糖尿病病程较长的患者不太可能达到 ≤7.0% (53 mmol/mol) 的 HbA1c 目标（39% 对 55%，p < 0.001），达到 ≤130/80 mmHg 的血压目标的可能性相似（38% 对 36%，p  = 0.26）并且与患者相比更有可能实现 ≤2.0 mmol/L（≤77.3 mg/dL）的 L​​DL-C 目标（63% 对 53%，p  < 0.001）糖尿病病程较短 ( n  = 3462)。两组之间所有三个目标的实现情况相似（13% 对 13%，p = 0.82)。总体而言，糖尿病病程较长的患者更有可能开具抗高血糖、抗高血压、降脂药物并转诊接受糖尿病教育。

结论

无论糖尿病病程长短，只有 13% 的患者达到了血糖、血压和 LDL-C 目标。尽管使用更多药物进行管理，但糖尿病病程较长的患者实现血糖目标的可能性较小。需要更多地关注开发方法来连接最佳护理和现实世界的实践。