Adherence to Canadian Diabetes Association Clinical Practice Guidelines for Patients Attending an Outpatient Diabetes Education Centre

ABSTRACT Background: Clinical practice guidelines can be a useful tool in the effort to improve patient outcomes. Objective: To determine the percentage of patients attending the Diabetes Education Centre at the Lions Gate Hospital for whom monitoring frequencies, laboratory targets, and medication therapy (as recommended in the 2003 clinical practice guidelines of the Canadian Diabetes Association) were achieved. Methods: Health records were reviewed for all patients with type 2 diabetes mellitus who were 19 to 69 years of age at the time of their first visit to the Diabetes Education Centre and whose first visit took place in 2004. Results: Initial monitoring frequencies for hemoglobin A1C, lipid profile, urinary albumin to creatinine ratio, and eye examination were achieved for a high proportion of the 167 patients who met the study criteria (63% to 93%). Recommended laboratory targets for hemoglobin A1C were achieved for a high proportion of patients (93%), but the rate was lower (21% to 44%) for other targets (fasting plasma glucose, blood pressure, low-density-lipoprotein cholesterol, and ratio of total cholesterol to high-density-lipoprotein cholesterol). Less than 60% (25% to 56%) of eligible patients received recommended medications (antihyperglycemic agents, antihypertensive agents, statins, and acetylsalicylic acid). Conclusions: For most patients, recommendations for initial monitoring were met, but more work is needed to ensure that laboratory targets are achieved, that appropriate medication therapy is initiated, and that the management of cardiovascular risk factors is emphasized. RESUME Historique : Les guides de pratique clinique peuvent constituer un outil utile pour essayer d'obtenir de meilleurs resultats therapeutiques. Objectif : Determiner le pourcentage de patients utilisant les services du Centre d’education sur le diabete de l’hopital Lions Gate, pour lesquels les frequences de controle, les objectifs de valeurs de laboratoire et le traitement medicamenteux etaient conformes aux Lignes directrices de pratique clinique de 2003 de l’Association canadienne du diabete. Methodes : Les dossiers medicaux de tous les patients atteints de diabete de type 2 et qui etaient âges de 19 a 69 ans au moment de leur premiere visite en 2004 au Centre d’education sur le diabete ont ete examines. Resultats : Les frequences de controle initiales pour l’HbA1C, le bilan lipidique, le rapport albuminurie/creatininurie et l’examen ophtalmologique (de 63 % a 93 %) ont ete respectees chez un fort pourcentage des 167 patients qui ont satisfait les criteres d’admissibilite. Le pourcentage de ces patients chez qui ont ete atteintes les valeurs de laboratoire recommandees etait eleve pour ce qui est de l’HbA1C (93 %), mais bas (de 21 % a 44 %) pour ce qui est des autres valeurs cibles (glycemie a jeun, tension arterielle, cholesterol des lipoproteines de basse densite, et rapport cholesterol total:cholesterol des lipoproteines de haute densite). Moins de 60 % (de 25 % a 56 %) des patients admissibles ont recu les medicaments recommandes (hypoglycemiants, antihypertenseurs, statines et acide acetylsalicylique). Conclusions : Les recommandations relativement au controle initial ont ete satisfaites chez la plupart des patients, mais plus d’efforts devront etre consentis pour atteindre les valeurs de laboratoire cibles, amorcer un traitement medicamenteux approprie et accorder plus d’importance a la prise en charge des facteurs de risque cardiovasculaire.