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Care Endpoints in Adults With Type 2 Diabetes: Screening and Therapeutic Targets at a Canadian Tertiary Diabetes Care Centre

      Abstract

      Objectives

      Although national diabetes guidelines recommend targets for various health parameters, studies have demonstrated a gap between recommendations and real-life practice. The objectives of the present study were to: 1) assess measurements in type 2 diabetes (T2DM) care performed by diabetologists in tertiary care, 2) determine whether these measurements were within recommended targets by Canadian guidelines, and 3) identify how these measurements compare with previously published Canadian studies.

      Methods

      A retrospective chart review analyzed electronic medical records of patients seen by diabetes specialists at the McGill University Health Centre (MUHC). Patients 18 to 75 years of age and diagnosed with T2DM were assessed for blood pressure <130/80 mmHg, low-density lipoprotein cholesterol (LDL-C) ≤2 mmol/L and glycated hemoglobin (A1C) ≤7%. Urinary albumin:creatinine ratio (uACR) was also assessed. Comparisons were made with existing literature data.

      Results

      The percentages of patients with recent screening of A1C, LDL-C, blood pressure and uACR were higher compared with the earlier studies. The calculated means for A1C, LDL-C and blood pressure were comparable with those studies. The percentage of measurements achieving target was comparable with subspecialty care data but differed from primary care data.

      Conclusions

      Patients with T2DM at the MUHC receive guideline-based measurements of health parameters more frequently than at other institutions. Achievement of target values was closer to that seen by Canadian specialists than by primary care. Although further analyses are necessary to help implement effective strategies for improvement, quality assurance is nonetheless an essential part of ensuring the standards of tertiary care.

      Résumé

      Objectifs

      Bien que les lignes directrices nationales sur le diabète fournissent des recommandations sur les valeurs cibles des divers paramètres de santé, des études ont démontré un écart entre les recommandations et la pratique réelle. Les objectifs de la présente étude visaient à : 1) évaluer les mesures de soins liés au diabète de type 2 (DT2) réalisées par les diabétologues en soins tertiaires; 2) déterminer si ces mesures se trouvaient dans les valeurs cibles recommandées; 3) préciser de quelle façon ces mesures sont comparables aux études canadiennes publiées antérieurement.

      Méthodes

      Une revue rétrospective de dossiers a permis d’analyser les dossiers médicaux électroniques des patients vus par des spécialistes en diabète au Centre universitaire de santé McGill (CUSM). Les patients qui avaient de 18 à 75 ans et un diagnostic de DT2 ont été évalués pour savoir s’ils avaient une pression artérielle < 130/80 mmHg, un cholestérol à lipoprotéines de faible densité (cholestérol LDL) ≤ 2 mmol/L et une hémoglobine glyquée (A1c) ≤ 7 %. Le rapport albumine/créatinine urinaire (RACu) a aussi été évalué. Des comparaisons ont été faites avec les données de la littérature existante.

      Résultats

      Les pourcentages de patients qui avaient récemment eu un dépistage de l’A1c, du cholestérol LDL, de la pression artérielle et du RACu étaient plus élevés que les pourcentages des études précédentes. Les moyennes calculées de l’A1c, du cholestérol LDL et de la pression artérielle étaient comparables aux moyennes de ces études. Le pourcentage des mesures atteignant les valeurs cibles était comparable aux données des soins de sous-spécialités, mais différait des données des soins primaires.

      Conclusions

      Les patients atteints du DT2 du CUSM obtiennent des mesures des paramètres de santé conformes aux lignes directrices plus fréquemment que les patients d’autres établissements. Les valeurs cibles atteintes étaient plus proches des valeurs observées par les spécialistes canadiens que des valeurs atteintes en soins primaires. Bien que des analyses plus approfondies soient nécessaires pour contribuer à la mise en œuvre de stratégies d’amélioration efficaces, l’assurance de la qualité est néanmoins essentielle pour garantir les normes en soins tertiaires.

      Keywords

      Mots clés

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