Type 2 Diabetes Mellitus Management in Canada: Is It Improving?

Lawrence A. Leiter; Lori Berard; C. Keith Bowering; Alice Y. Cheng; Keith G. Dawson; Jean Marie Ekoé; Carl Fournier; Lianne Goldin; Stewart B. Harris; Peter Lin; Thomas Ransom; Mary Tan; Hwee Teoh; Ross T. Tsuyuki; Dana Whitham; Vincent Woo; Jean François Yale; Anatoly Langer

doi:10.1016/j.jcjd.2013.02.055

Type 2 Diabetes Mellitus Management in Canada: Is It Improving?

Lawrence A. Leiter, Lori Berard, C. Keith Bowering, Alice Y. Cheng, Keith G. Dawson, Jean Marie Ekoé, Carl Fournier, Lianne Goldin, Stewart B. Harris, Peter Lin, Thomas Ransom, Mary Tan, Hwee Teoh, Ross T. Tsuyuki, Dana Whitham, Vincent Woo, Jean François Yale, Anatoly Langer

Medicine

Research output: Contribution to journal › Article › peer-review

130 Citations (Scopus)

Abstract

Objective: To gain insight into the current management of patients with type 2 diabetes mellitus by Canadian primary care physicians. Method: A total of 479 primary care physicians from across Canada submitted data on 5123 type 2 diabetes patients whom they had seen on a single day on or around World Diabetes Day, November 14, 2012. Results: Mean glycated hemoglobin (A1C) was 7.4%, low-density lipoprotein (LDL-C) was 2.1 mmol/L and blood pressure (BP) was 128/75 mm Hg. A1C ≤7.0% was met by 50%, LDL-C ≤2.0 mmol/L by 57%, BP <130/80 mm Hg by 36% and the composite triple target by 13% of patients. Diet counselling had been offered to 38% of patients. Of the 87% prescribed antihyperglycemic agents, 18% were on 1 non-insulin antihyperglycemic agent (NIAHA) (85% of which was metformin), 15% were on 2 NIAHAs, 6% were on ≥3 NIAHAs, 19% were on insulin only and 42% were on insulin + ≥1 NIAHA(s). Amongst the 81% prescribed lipid-lowering therapy, 88% were on monotherapy (97% of which was a statin). Among the 83% prescribed antihypertensive agents, 39%, 34%, 21% and 6% received 1, 2, 3 and >3 drugs, respectively, with 59% prescribed angiotensin-converting enzyme inhibitors and 35% angiotensin II receptor blockers. Conclusions: The Diabetes Mellitus Status in Canada survey highlights the persistent treatment gap associated with the treatment of type 2 diabetes and the challenges faced by primary care physicians to gain glycemic control and global vascular protection in these patients. It also reveals a higher use of insulin therapy in primary care practices relative to previous surveys. Practical strategies aimed at more effectively managing type 2 diabetes patients are urgently needed.

Original language	English
Pages (from-to)	82-89
Number of pages	8
Journal	Canadian Journal of Diabetes
Volume	37
Issue number	2
DOIs	https://doi.org/10.1016/j.jcjd.2013.02.055
Publication status	Published - Apr 2013

Bibliographical note

Funding Information:
The Diabetes Mellitus Status in Canada (DM-SCAN) survey was made possible through the support of Merck Canada Inc . The opinions expressed in this material are those of the authors and do not necessarily reflect the views of Merck Canada Inc.

Funding Information:
LAL has received honouraria or research support from Amgen , AstraZeneca , Boehringer Ingelheim , Bristol-Myers Squibb , Eli Lilly , GlaxoSmithKline , Janssen , Merck , Novartis , Novo Nordisk , Sanofi , Servier and Takeda . LB has received honouraria or research support from AstraZeneca , Bristol-Myers Squibb , Eli Lilly , Janssen , Merck , Novo Nordisk and Sanofi . CKB has received honouraria or research support from AstraZeneca , Boehringer Ingelheim , Bristol-Myers Squibb , Eli Lilly , Merck , Novartis , Novo Nordisk , Pfizer and Sanofi . AYC has received honouraria or research support from Abbott , AstraZeneca - Bristol-Myers Squibb , Becton Dickinson , Eli Lilly , Eli Lilly , Lifescan , Merck , Novo Nordisk , Sanofi and Servier . KGD has received honouraria or research support from GlaxoSmithKline , Lifescan , Lilly , Merck , Novo Nordisk and Sanofi . J-ME has received honouraria or research support from Merck . CF has received honouraria or research support from Amgen , AstraZeneca , Boehringer Ingelheim , Bristol-Myers Squibb , Forrest , Janssen , Sanofi , Takeda and Valeant . LG has no conflicts of interest to declare. SBH has received honouraria or research support from AstraZeneca - Bristol-Myers Squibb , Boehringer Ingelheim-Eli Lilly , Janssen , Merck , NovoNordisk , Roche , Sanofi and Takeda . PL has received honouraria or research support from AstraZeneca , Boehringer Ingelheim , Eli Lilly , Merck , NovoNordisk , Sanofi and Takeda . TR has received honouraria or research support from AstraZeneca , Boehringer Ingelheim , Bristol-Myers Squibb , Eli Lilly , GlaxoSmithKline , Merck , Novartis , NovoNordisk and Sanofi . MT has no conflicts of interest to declare. HT has no conflicts of interest to declare. RTT has received honouraria or research support from Abbott , AstraZeneca , Bristol-Myers Squibb-AstraZeneca , Boehringer Ingelheim , Merck , PharmaSmart and Sanofi . DW has no conflicts of interest to declare. VW has received honouraria or research support from AstraZeneca , Boehringer Ingelheim , Bristol-Myers Squibb , Eli Lilly , Forrest , Janssen , Merck , Novo Nordisk and Sanofi . J-FY has received honouraria or research support from AstraZeneca , Boehringer Ingelheim , Bristol-Myers Squibb , Eli Lilly , Janssen , Merck , Novo Nordisk , Sanofi and Takeda . AL has received honouraria or research support from Actelion , AstraZeneca , Aventis , Bayer , Biovail , Boston Scientific , Bristol-Myers Squibb/Sanofi Pharmaceuticals Partnership , Cordis , Guidant , Medtronics , Merck , Millennium Pharmaceuticals , Ortho Biotec , Oryx , Pfizer , Roche , Sanofi-Synthelabo , Schering Key Corporation , Servier , The Medicines Company and United Therapeutics .

ASJC Scopus Subject Areas

Internal Medicine
Endocrinology, Diabetes and Metabolism
Endocrinology

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.jcjd.2013.02.055

Cite this

Leiter, L. A., Berard, L., Bowering, C. K., Cheng, A. Y., Dawson, K. G., Ekoé, J. M., Fournier, C., Goldin, L., Harris, S. B., Lin, P., Ransom, T., Tan, M., Teoh, H., Tsuyuki, R. T., Whitham, D., Woo, V., Yale, J. F., & Langer, A. (2013). Type 2 Diabetes Mellitus Management in Canada: Is It Improving? Canadian Journal of Diabetes, 37(2), 82-89. https://doi.org/10.1016/j.jcjd.2013.02.055

@article{49c60ea2e290419a8bbf4028d516e452,

title = "Type 2 Diabetes Mellitus Management in Canada: Is It Improving?",

abstract = "Objective: To gain insight into the current management of patients with type 2 diabetes mellitus by Canadian primary care physicians. Method: A total of 479 primary care physicians from across Canada submitted data on 5123 type 2 diabetes patients whom they had seen on a single day on or around World Diabetes Day, November 14, 2012. Results: Mean glycated hemoglobin (A1C) was 7.4%, low-density lipoprotein (LDL-C) was 2.1 mmol/L and blood pressure (BP) was 128/75 mm Hg. A1C ≤7.0% was met by 50%, LDL-C ≤2.0 mmol/L by 57%, BP <130/80 mm Hg by 36% and the composite triple target by 13% of patients. Diet counselling had been offered to 38% of patients. Of the 87% prescribed antihyperglycemic agents, 18% were on 1 non-insulin antihyperglycemic agent (NIAHA) (85% of which was metformin), 15% were on 2 NIAHAs, 6% were on ≥3 NIAHAs, 19% were on insulin only and 42% were on insulin + ≥1 NIAHA(s). Amongst the 81% prescribed lipid-lowering therapy, 88% were on monotherapy (97% of which was a statin). Among the 83% prescribed antihypertensive agents, 39%, 34%, 21% and 6% received 1, 2, 3 and >3 drugs, respectively, with 59% prescribed angiotensin-converting enzyme inhibitors and 35% angiotensin II receptor blockers. Conclusions: The Diabetes Mellitus Status in Canada survey highlights the persistent treatment gap associated with the treatment of type 2 diabetes and the challenges faced by primary care physicians to gain glycemic control and global vascular protection in these patients. It also reveals a higher use of insulin therapy in primary care practices relative to previous surveys. Practical strategies aimed at more effectively managing type 2 diabetes patients are urgently needed.",

author = "Leiter, {Lawrence A.} and Lori Berard and Bowering, {C. Keith} and Cheng, {Alice Y.} and Dawson, {Keith G.} and Eko{\'e}, {Jean Marie} and Carl Fournier and Lianne Goldin and Harris, {Stewart B.} and Peter Lin and Thomas Ransom and Mary Tan and Hwee Teoh and Tsuyuki, {Ross T.} and Dana Whitham and Vincent Woo and Yale, {Jean Fran{\c c}ois} and Anatoly Langer",

note = "Funding Information: The Diabetes Mellitus Status in Canada (DM-SCAN) survey was made possible through the support of Merck Canada Inc . The opinions expressed in this material are those of the authors and do not necessarily reflect the views of Merck Canada Inc. Funding Information: LAL has received honouraria or research support from Amgen , AstraZeneca , Boehringer Ingelheim , Bristol-Myers Squibb , Eli Lilly , GlaxoSmithKline , Janssen , Merck , Novartis , Novo Nordisk , Sanofi , Servier and Takeda . LB has received honouraria or research support from AstraZeneca , Bristol-Myers Squibb , Eli Lilly , Janssen , Merck , Novo Nordisk and Sanofi . CKB has received honouraria or research support from AstraZeneca , Boehringer Ingelheim , Bristol-Myers Squibb , Eli Lilly , Merck , Novartis , Novo Nordisk , Pfizer and Sanofi . AYC has received honouraria or research support from Abbott , AstraZeneca - Bristol-Myers Squibb , Becton Dickinson , Eli Lilly , Eli Lilly , Lifescan , Merck , Novo Nordisk , Sanofi and Servier . KGD has received honouraria or research support from GlaxoSmithKline , Lifescan , Lilly , Merck , Novo Nordisk and Sanofi . J-ME has received honouraria or research support from Merck . CF has received honouraria or research support from Amgen , AstraZeneca , Boehringer Ingelheim , Bristol-Myers Squibb , Forrest , Janssen , Sanofi , Takeda and Valeant . LG has no conflicts of interest to declare. SBH has received honouraria or research support from AstraZeneca - Bristol-Myers Squibb , Boehringer Ingelheim-Eli Lilly , Janssen , Merck , NovoNordisk , Roche , Sanofi and Takeda . PL has received honouraria or research support from AstraZeneca , Boehringer Ingelheim , Eli Lilly , Merck , NovoNordisk , Sanofi and Takeda . TR has received honouraria or research support from AstraZeneca , Boehringer Ingelheim , Bristol-Myers Squibb , Eli Lilly , GlaxoSmithKline , Merck , Novartis , NovoNordisk and Sanofi . MT has no conflicts of interest to declare. HT has no conflicts of interest to declare. RTT has received honouraria or research support from Abbott , AstraZeneca , Bristol-Myers Squibb-AstraZeneca , Boehringer Ingelheim , Merck , PharmaSmart and Sanofi . DW has no conflicts of interest to declare. VW has received honouraria or research support from AstraZeneca , Boehringer Ingelheim , Bristol-Myers Squibb , Eli Lilly , Forrest , Janssen , Merck , Novo Nordisk and Sanofi . J-FY has received honouraria or research support from AstraZeneca , Boehringer Ingelheim , Bristol-Myers Squibb , Eli Lilly , Janssen , Merck , Novo Nordisk , Sanofi and Takeda . AL has received honouraria or research support from Actelion , AstraZeneca , Aventis , Bayer , Biovail , Boston Scientific , Bristol-Myers Squibb/Sanofi Pharmaceuticals Partnership , Cordis , Guidant , Medtronics , Merck , Millennium Pharmaceuticals , Ortho Biotec , Oryx , Pfizer , Roche , Sanofi-Synthelabo , Schering Key Corporation , Servier , The Medicines Company and United Therapeutics . ",

year = "2013",

month = apr,

doi = "10.1016/j.jcjd.2013.02.055",

language = "English",

volume = "37",

pages = "82--89",

journal = "Canadian Journal of Diabetes",

issn = "1499-2671",

publisher = "Canadian Diabetes Association",

number = "2",

}

TY - JOUR

T1 - Type 2 Diabetes Mellitus Management in Canada

T2 - Is It Improving?

AU - Leiter, Lawrence A.

AU - Berard, Lori

AU - Bowering, C. Keith

AU - Cheng, Alice Y.

AU - Dawson, Keith G.

AU - Ekoé, Jean Marie

AU - Fournier, Carl

AU - Goldin, Lianne

AU - Harris, Stewart B.

AU - Lin, Peter

AU - Ransom, Thomas

AU - Tan, Mary

AU - Teoh, Hwee

AU - Tsuyuki, Ross T.

AU - Whitham, Dana

AU - Woo, Vincent

AU - Yale, Jean François

AU - Langer, Anatoly

N1 - Funding Information: The Diabetes Mellitus Status in Canada (DM-SCAN) survey was made possible through the support of Merck Canada Inc . The opinions expressed in this material are those of the authors and do not necessarily reflect the views of Merck Canada Inc. Funding Information: LAL has received honouraria or research support from Amgen , AstraZeneca , Boehringer Ingelheim , Bristol-Myers Squibb , Eli Lilly , GlaxoSmithKline , Janssen , Merck , Novartis , Novo Nordisk , Sanofi , Servier and Takeda . LB has received honouraria or research support from AstraZeneca , Bristol-Myers Squibb , Eli Lilly , Janssen , Merck , Novo Nordisk and Sanofi . CKB has received honouraria or research support from AstraZeneca , Boehringer Ingelheim , Bristol-Myers Squibb , Eli Lilly , Merck , Novartis , Novo Nordisk , Pfizer and Sanofi . AYC has received honouraria or research support from Abbott , AstraZeneca - Bristol-Myers Squibb , Becton Dickinson , Eli Lilly , Eli Lilly , Lifescan , Merck , Novo Nordisk , Sanofi and Servier . KGD has received honouraria or research support from GlaxoSmithKline , Lifescan , Lilly , Merck , Novo Nordisk and Sanofi . J-ME has received honouraria or research support from Merck . CF has received honouraria or research support from Amgen , AstraZeneca , Boehringer Ingelheim , Bristol-Myers Squibb , Forrest , Janssen , Sanofi , Takeda and Valeant . LG has no conflicts of interest to declare. SBH has received honouraria or research support from AstraZeneca - Bristol-Myers Squibb , Boehringer Ingelheim-Eli Lilly , Janssen , Merck , NovoNordisk , Roche , Sanofi and Takeda . PL has received honouraria or research support from AstraZeneca , Boehringer Ingelheim , Eli Lilly , Merck , NovoNordisk , Sanofi and Takeda . TR has received honouraria or research support from AstraZeneca , Boehringer Ingelheim , Bristol-Myers Squibb , Eli Lilly , GlaxoSmithKline , Merck , Novartis , NovoNordisk and Sanofi . MT has no conflicts of interest to declare. HT has no conflicts of interest to declare. RTT has received honouraria or research support from Abbott , AstraZeneca , Bristol-Myers Squibb-AstraZeneca , Boehringer Ingelheim , Merck , PharmaSmart and Sanofi . DW has no conflicts of interest to declare. VW has received honouraria or research support from AstraZeneca , Boehringer Ingelheim , Bristol-Myers Squibb , Eli Lilly , Forrest , Janssen , Merck , Novo Nordisk and Sanofi . J-FY has received honouraria or research support from AstraZeneca , Boehringer Ingelheim , Bristol-Myers Squibb , Eli Lilly , Janssen , Merck , Novo Nordisk , Sanofi and Takeda . AL has received honouraria or research support from Actelion , AstraZeneca , Aventis , Bayer , Biovail , Boston Scientific , Bristol-Myers Squibb/Sanofi Pharmaceuticals Partnership , Cordis , Guidant , Medtronics , Merck , Millennium Pharmaceuticals , Ortho Biotec , Oryx , Pfizer , Roche , Sanofi-Synthelabo , Schering Key Corporation , Servier , The Medicines Company and United Therapeutics .

PY - 2013/4

Y1 - 2013/4

N2 - Objective: To gain insight into the current management of patients with type 2 diabetes mellitus by Canadian primary care physicians. Method: A total of 479 primary care physicians from across Canada submitted data on 5123 type 2 diabetes patients whom they had seen on a single day on or around World Diabetes Day, November 14, 2012. Results: Mean glycated hemoglobin (A1C) was 7.4%, low-density lipoprotein (LDL-C) was 2.1 mmol/L and blood pressure (BP) was 128/75 mm Hg. A1C ≤7.0% was met by 50%, LDL-C ≤2.0 mmol/L by 57%, BP <130/80 mm Hg by 36% and the composite triple target by 13% of patients. Diet counselling had been offered to 38% of patients. Of the 87% prescribed antihyperglycemic agents, 18% were on 1 non-insulin antihyperglycemic agent (NIAHA) (85% of which was metformin), 15% were on 2 NIAHAs, 6% were on ≥3 NIAHAs, 19% were on insulin only and 42% were on insulin + ≥1 NIAHA(s). Amongst the 81% prescribed lipid-lowering therapy, 88% were on monotherapy (97% of which was a statin). Among the 83% prescribed antihypertensive agents, 39%, 34%, 21% and 6% received 1, 2, 3 and >3 drugs, respectively, with 59% prescribed angiotensin-converting enzyme inhibitors and 35% angiotensin II receptor blockers. Conclusions: The Diabetes Mellitus Status in Canada survey highlights the persistent treatment gap associated with the treatment of type 2 diabetes and the challenges faced by primary care physicians to gain glycemic control and global vascular protection in these patients. It also reveals a higher use of insulin therapy in primary care practices relative to previous surveys. Practical strategies aimed at more effectively managing type 2 diabetes patients are urgently needed.

AB - Objective: To gain insight into the current management of patients with type 2 diabetes mellitus by Canadian primary care physicians. Method: A total of 479 primary care physicians from across Canada submitted data on 5123 type 2 diabetes patients whom they had seen on a single day on or around World Diabetes Day, November 14, 2012. Results: Mean glycated hemoglobin (A1C) was 7.4%, low-density lipoprotein (LDL-C) was 2.1 mmol/L and blood pressure (BP) was 128/75 mm Hg. A1C ≤7.0% was met by 50%, LDL-C ≤2.0 mmol/L by 57%, BP <130/80 mm Hg by 36% and the composite triple target by 13% of patients. Diet counselling had been offered to 38% of patients. Of the 87% prescribed antihyperglycemic agents, 18% were on 1 non-insulin antihyperglycemic agent (NIAHA) (85% of which was metformin), 15% were on 2 NIAHAs, 6% were on ≥3 NIAHAs, 19% were on insulin only and 42% were on insulin + ≥1 NIAHA(s). Amongst the 81% prescribed lipid-lowering therapy, 88% were on monotherapy (97% of which was a statin). Among the 83% prescribed antihypertensive agents, 39%, 34%, 21% and 6% received 1, 2, 3 and >3 drugs, respectively, with 59% prescribed angiotensin-converting enzyme inhibitors and 35% angiotensin II receptor blockers. Conclusions: The Diabetes Mellitus Status in Canada survey highlights the persistent treatment gap associated with the treatment of type 2 diabetes and the challenges faced by primary care physicians to gain glycemic control and global vascular protection in these patients. It also reveals a higher use of insulin therapy in primary care practices relative to previous surveys. Practical strategies aimed at more effectively managing type 2 diabetes patients are urgently needed.

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Type 2 Diabetes Mellitus Management in Canada: Is It Improving?

Abstract

Bibliographical note

ASJC Scopus Subject Areas

UN SDGs

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