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Www.dmscan.ca The DM-SCAN program has been made possible through the support of Merck Canada Inc. The opinions expressed in this material are those of.

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Presentation on theme: "Www.dmscan.ca The DM-SCAN program has been made possible through the support of Merck Canada Inc. The opinions expressed in this material are those of."— Presentation transcript:

1 The DM-SCAN program has been 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.

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3 Steering Committee Members Western Canada: Lori Berard, RN, CDE – Nurse and Certified Diabetes Educator – Winnipeg, MB Keith Bowering, MD – Endocrinologist – Edmonton, AB Keith Dawson, MD – Endocrinologist – Vancouver, BC Ross Tsuyuki, PharmD – Academic Pharmacist – Calgary AB Vincent Woo, MD – Endocrinologist – Winnipeg, MB Ontario: Alice Cheng, MD – Endocrinologist – Toronto, ON Stewart Harris, MD – Primary Care Physician/Diabetes Expert – London, ON Anatoly Langer MD – Cardiologist – Toronto, ON Lawrence Leiter, MD (Chair) – Endocrinologist – Toronto, ON Peter Lin, MD – Primary Care Physician – Toronto, ON Dana Whitham, RD, MSc, CDE – Dietitian and Certified Diabetes Educator – Toronto, ON Quebec: Jean-Marie Ekoé, MD – Endocrinologist – Montreal, QC Carl Fournier, MD – Primary Care Physician – Montreal, QC Jean-Francois Yale, MD – Endocrinologist – Montreal, QC Atlantic Canada: Thomas Ransom, MD – Endocrinologist – Halifax, NS

4 Program Objectives To evaluate and gain insight into the current status and management of patients with Type 2 Diabetes in Canada in the primary care setting To highlight the public health burden of Type 2 Diabetes To identify management gaps to help design educational programs of practical value to primary care physicians

5 Program Overview Assess the current management of patients with type 2 diabetes by completing a simple one-page Data Collection Form on ALL patients seen as part of routine clinical practice on or as close as possible to World Diabetes Day (November 14, 2012)

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7 National Physician and Patient Representation AB MDs – n=29 DCFs – n=233 BC MDs – n=41 DCFs – n=365 MB MDs – n=19 DCFs – n=249 SK MDs – n=3 DCFs – n=21 ON MDs – n=270 DCFs – n=2990 QC MDs – n =45 DCFs – n=400 NB-PEI MDs – n=27 DCFs – n=362 NS MDs – n=28 DCFs – n=295 NL MDs – n=17 DCFs – n=208 MDs – N = 479 DCFs – N = 5123 Avg. number of DCF*s/MD - 11 * DCF – Data Collection Form

8 Practice Setting 50% of the physician participants identified being a part of a Family Health Team

9 Physician Practice – Geographic Setting

10 Practice Survey Question: On average, how many patients with Type 2 Diabetes do you see in a week? Number of patients % - physician responses Less than 51% 5 to 1013% 10 to 2036% 20 to 3027% 30 to 5016% More than 507%

11 Percent of patients% - physician responses None3% 1 to 25%56% 26 to 50%19% > 50%22% Practice Survey Question: Approximately what proportion of your patients have their type 2 diabetes co-managed by an allied health care professional (in your office or local diabetes education centre)?

12 Practice Survey Question: Please identify the greatest barriers to managing patients with diabetes: Top Five Responses: 1.Patient non-compliance 2.Patient resistance 3.Constraints on physician’s time 4.Financial barriers 5.Lack of support for the physician

13 Patient Demographics * Data presented as mean (SD) Female Sex: n=2353 Available Records 4707 Age: n=5090 Duration of T2DM: n= % Age* 64 (12) Duration of T2DM* 9 (7) L.A. Leiter et al. / Can J Diabetes 37 (2013) 82-89

14 Patient Ethnicity Aboriginal Canadian 3% Black 4% Caucasian 61% East / SE Asian 17% Hispanic 2% South Asian 11% Other 3% N = records unavailable L.A. Leiter et al. / Can J Diabetes 37 (2013) 82-89

15 Summary of Patient BMI Categories Category Percent of Patients Normal Weight14% Overweight29% Obese57% Body Mass Index (kg/m 2 )Mean (SD) Men 30.5 (10) Women 31.1 (11.6) N = 5123* N for each category was variable due to missing values, <10% in each case. L.A. Leiter et al. / Can J Diabetes 37 (2013) 82-89

16 Health Behaviours 38% of patients had been referred to or counselled by a registered dietitian or a certified diabetes educator within the last 12 months (n=4787) 50% of patients had a nutrition / exercise / weight loss plan with measurable goals established in the past 12 months (n=4776) L.A. Leiter et al. / Can J Diabetes 37 (2013) 82-89

17 Glycemic and Renal Profile Measure N Mean + SD Guideline Recommendations A1C (%) <7.0% Fasting Plasma Glucose (mmol/L) – 7.0 Creatinine (µmol/L) N / A eGFR (mL/min) N / A Urine Albumin Creatinine Ratio (mg/mmol) <2.0 (men) <2.8 (women) L.A. Leiter et al. / Can J Diabetes 37 (2013) 82-89

18 Insulin Use by Number of Injections per Day % of patients * NIAHA – Non Insulin Antihyperglycemic Agent L.A. Leiter et al. / Can J Diabetes 37 (2013) 82-89

19 Glycemic Management N = 4477 Medical ManagementN% of Patients 1 NIAHA* - 85% treated with Metformin80218% 2 NIAHAs67315% ≥ 3 NIAHAs2616% Insulin alone85419% Insulin + ≥ 1 NIAHAs188742% * NIAHA - non-insulin antihyperglycemic agent L.A. Leiter et al. / Can J Diabetes 37 (2013) 82-89

20 A1C Values Achieved N = 5103 % of patients A1C (%) L.A. Leiter et al. / Can J Diabetes 37 (2013) In 81% of patients, the A1C goal set by the physicians was ≤7%.

21 A1C <7% Attainment Rates based on Duration of Diabetes L.A. Leiter et al. / Can J Diabetes 37 (2013) 82-89

22 Lipid Profile N = 5069 Measure Mean + SDGuideline Recommendations LDL <2.0 mmol/L L.A. Leiter et al. / Can J Diabetes 37 (2013) 82-89

23 Lipid Management Management % of Patients Monotherapy 88% Statin alone 85% 2 Lipid Lowering Agents 11% Statin + Cholesterol Absorption Inhibitor 8% > 2 Lipid Lowering Agents <1% N = 4153 L.A. Leiter et al. / Can J Diabetes 37 (2013) 82-89

24 LDL-C Values Achieved N = 5069 % of patients LDL-C (mmol/L) L.A. Leiter et al. / Can J Diabetes 37 (2013) 82-89

25 LDL-C Values Achieved – Presence and Absence of Vascular Disease L.A. Leiter et al. / Can J Diabetes 37 (2013) 82-89

26 Lipid Control and Management of DM-SCAN Patients L.A. Leiter et al. / Can J Diabetes 37 (2013) 82-89

27 Blood Pressure Profile Systolic Blood Pressure: N = 5103, Diastolic Blood Pressure: N = 5099 Measure Mean + SD Guideline Recommendations SBP < 130 mm Hg DBP < 80 mm Hg L.A. Leiter et al. / Can J Diabetes 37 (2013) 82-89

28 Blood Pressure Management N = 4946 Management % of Patients BP recorded (Nov / Dec 2012) 70% Not treated with BP medication 17% N = 4272 Monotherapy 39% 2 Agents 34% 3 Agents 21% 3+ Agents 6% L.A. Leiter et al. / Can J Diabetes 37 (2013) 82-89

29 Blood Pressure Values Achieved N = 5099 % of patients SBP / DBP (mm Hg) L.A. Leiter et al. / Can J Diabetes 37 (2013) 82-89

30 Distribution of Antihypertensive Therapy Strategies Prescribed to Patients with Blood Pressure >130/80 mmHg N = 1494 L.A. Leiter et al. / Can J Diabetes 37 (2013) 82-89

31 Guideline Targets Achieved for A1C, LDL-C and Blood Pressure % of patients L.A. Leiter et al. / Can J Diabetes 37 (2013) 82-89

32 Patient Comorbidities % of patients L.A. Leiter et al. / Can J Diabetes 37 (2013) 82-89

33 Has glycemic management improved over the last decade? DICE ( ) N = 2473 DRIVE ( ) N = 3002 DM-SCAN (Nov-Dec 2012) N=5123 Age at audit, years Time since diagnosis, years Female, % BMI, kg/m 2 31 A1C, % A1C >7.0%, proportion of patients Harris S, et al. Diabetes Res Clin Prac. 2005;70(1): Braga M, et al. Can J Cardiol. 2010;26(6): Note: All data reported as mean


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