Treatment gaps in the management of cardiovascular risk factors in patients with type 2 diabetes in Canada
Treatment gaps in the management of cardiovascular risk factors in patients with type 2 diabetes in Canada
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DOI：
10.1016/s0828-282x(10)70393-7
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发表时间：
2010-06-01
影响因子：
6.2
通讯作者：
Leiter, Lawrence A.
中科院分区：
文献类型：
--
作者：
Braga, Manoela F. B.;Casanova, Amparo;Leiter, Lawrence A.
目的：为了评估血管保护治疗模式和实现2003年加拿大糖尿病协会的建议目标，在门诊2型diabetes.METHODS患者：2005年和2006年之间，3002例2型糖尿病门诊患者参加了229个初级卫生保健设置在加拿大。基线特征、治疗方案和治疗成功定义为达到130/80 mmHg或更低的血压（BP）、7%或更低的糖化血红蛋白（A1 C）、低于2.5 mmol/L的低密度脂蛋白胆固醇（LDL-C）和低于4.0的总胆固醇/高密度脂蛋白胆固醇比率。总体而言，46%的人的血压高于加拿大糖尿病协会的建议目标。其中，11%未接受治疗，28%接受单药治疗，38%未接受血管紧张素转换酶抑制剂，16%未接受血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂。53%的患者达到最佳A1 C水平。在未达到A1 C目标的患者中，3%未接受降糖药物治疗，27%接受单药治疗。共有74%的患者接受了他汀类药物治疗。总体而言，分别有64%和62%的患者达到了目标LDL-C和目标总胆固醇/高密度脂蛋白胆固醇比值。43%的LDL-C高于目标的患者未接受他汀类药物治疗。81%的患者进行了抗血小板治疗。总的来说，21%的患者达到了BP，A1 C和LDL-C的联合目标。解释：相当大比例的患者没有达到指南推荐的目标，并且在加拿大指南发布两年后没有接受循证治疗进行血管保护。需要进行更多的研究，并且必须测试和实施新颖有效的策略来纠正这种持续的治疗差距。
OBJECTIVES: To evaluate vascular protection treatment patterns and attainment of the 2003 Canadian Diabetes Association's recommended targets in ambulatory patients with type 2 diabetes.METHODS: Between 2005 and 2006, 3002 outpatients with type 2 diabetes were enrolled by 229 primary health care settings across Canada. Baseline characteristics, therapeutic regimens and treatment success defined as the achievement of a blood pressure (BP) of 130/80 mmHg or lower, glycosylated hemoglobin (A1C) of 7% or lower, low-density lipoprotein cholesterol (LDL-C) lower than 2.5 mmol/L and total cholesterol/high-density lipoprotein cholesterol ratio lower than 4.0 - are reported.RESULTS: Overall, 46% of individuals had a BP that was above the Canadian Diabetes Association's recommended target. Of these, 11% were untreated, 28% were receiving monotherapy, 38% were not receiving an angiotensin-converting enzyme inhibitor and 16% were not receiving either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Optimal A1C levels were achieved in 53% of patients. Of those who did not attain A1C targets, 3% were not on glucose-lowering pharmacotherapy and 27% were receiving monotherapy. A total of 74% of patients were treated with statins. Overall, 64% and 62%, respectively, met the target LDL-C and the target total cholesterol/high-density lipoprotein cholesterol ratio. Statins were not prescribed to 43% of patients with LDL-C above target. Antiplateler therapy was implemented in 81% of patients. In total, 21% achieved the combined targets for BP, A1C and LDL-C.INTERPRETATION: A substantial proportion of patients did not achieve guideline-recommended targets and were not receiving evidence-based therapy for vascular protection two years after publication of the Canadian guidelines. More research is warranted, and novel and effective strategies must be tested and implemented to correct this ongoing treatment gap.