Type 2 Diabetes (T2D) Management in Primary Care: Still Room for Improvement

Abstract

The Diabetes Mellitus Assessment of Clinical managemenT In ONtario (DM-ACTION) program sought insights into the management of adults with T2D not at guideline recommended A1C. 88 primary care physicians completed practice surveys, 90% of whom saw >10 persons with diabetes/week. Between 9/2016 and 5/2017, data from 1165 adults with T2D, recent A1C ≥7.3%, and managed with lifestyle strategies ± non-insulin antihyperglycemic agents (AHAs) were analyzed. The cohort (60% men) had a median (interquartile range) age of 61 (53–68) years, T2D for 8 (5–12) years, A1C 7.8 (7.4–8.5)%, BP 126/78 (120–132/70–80) mmHg and LDL-C 1.9 (1.4–2.6) mmol/L. BP <130/80 mmHg was documented for 44%; LDL-C≤2.0 mmol/L for 57%; 28% met both targets. Most (86%) had a BMI ≥25.0 kg/m2; 66% had hypertension, 69% dyslipidemia and 10% had an eGFR<60 mL/min/1.73m2. Most (83%) were using ≤3 AHAs. Although 94% of the physicians reported typically initiating/adding an AHA within 3 months for unmet A1C goals, AHA uptitration/initiation/switching was only recorded for 56% of the patient cohort. Furthermore, the last two A1C measurements were 5 (3–7) months apart; only 21% had a≥0.5% A1C decrease while 34% had a≥0.5% increase. Suboptimal glycemic control was most commonly attributed to non-adherence.