Division of Endocrinology and Metabolism, Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada.
Can J Diabetes. 2013 Apr;37(2):82-9. doi: 10.1016/j.jcjd.2013.02.055. Epub 2013 Apr 23.
To gain insight into the current management of patients with type 2 diabetes mellitus by Canadian primary care physicians.
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.
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.
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.
了解加拿大初级保健医生对 2 型糖尿病患者的治疗现状。
2012 年 11 月 14 日，即世界糖尿病日前后，加拿大各地的 479 名初级保健医生对他们在一天内诊治的 5123 名 2 型糖尿病患者的数据进行了上报。
糖化血红蛋白（HbA1c）平均为 7.4%，低密度脂蛋白（LDL-C）为 2.1mmol/L，血压（BP）为 128/75mmHg。HbA1c≤7.0%的患者占 50%，LDL-C≤2.0mmol/L的患者占 57%，BP＜130/80mmHg的患者占 36%，复合三重目标的患者占 13%。38%的患者接受了饮食咨询。在开具的降糖药物中，87%的患者接受了抗高血糖药物治疗，其中 18%的患者使用了 1 种非胰岛素类抗高血糖药物（NIAHA）（85%为二甲双胍），15%的患者使用了 2 种 NIAHA，6%的患者使用了≥3 种 NIAHA，19%的患者仅使用胰岛素，42%的患者使用胰岛素+≥1 种 NIAHA。在开具调脂药物的 81%的患者中，88%接受了单一药物治疗（97%为他汀类药物）。在开具降压药物的 83%的患者中，分别有 39%、34%、21%和 6%的患者接受了 1、2、3 和>3 种药物治疗，59%的患者接受了血管紧张素转换酶抑制剂治疗，35%的患者接受了血管紧张素Ⅱ受体阻滞剂治疗。
加拿大糖尿病现状调查强调了在治疗 2 型糖尿病方面持续存在的治疗差距，以及初级保健医生在这些患者中实现血糖控制和全面血管保护所面临的挑战。该调查还显示，与以往的调查相比，胰岛素治疗在初级保健实践中的应用更为普遍。迫切需要制定切实可行的策略，以更有效地管理 2 型糖尿病患者。
