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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Article Info
Publication History
Published online: July 18, 2022
Accepted:
July 9,
2022
Received in revised form:
June 23,
2022
Received:
April 13,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Canadian Diabetes Association.
