Article Text
Abstract
Objective Diabetes guidelines recommend individualized glycemic targets: tighter control in younger, healthier patients and consideration of more moderate control in the elderly and those with coexisting illnesses. Our objective was to examine whether glycemic control varied by age and comorbidities in Canadian primary care.
Research design and methods Cross-sectional study using data from the electronic medical records of 537 primary care providers across Canada; 30 416 patients with diabetes, aged 40 or above, with at least one encounter and one hemoglobin A1c (HbA1c) measurement between 1 January 2012 and 31 December 2013. The outcome was the most recent HbA1c, categorized into three levels of control: tight (<7.0% or <53 mmol/mol), moderate (7.0%–8.5%, 53 mmol/mol–69.5 mmol/mol) and uncontrolled (>8.5% or >69.5 mmol/mol). We adjusted for several factors associated with glycemic control including treatment intensity.
Results Younger patients (aged 40–49) were more likely to have moderate as opposed to tight control than the older patients (aged 80+) (OR 1.28; 95% CI 1.11 to 1.49, p=0.001). The youngest were also more likely to have uncontrolled as opposed to moderately controlled glycemia (OR 3.39; 95% CI 2.75 to 4.17, p<0.0001). Patients with no or only one comorbidity were more likely to have moderate as opposed to tight control than those with three or more comorbidities (OR 1.66;95% CI 1.46 to 1.90, p<0.0001).
Conclusions Levels of glycemic control, given age and comorbidities appear to differ from guideline recommendations. Research is needed to understand these discrepancies and develop methods to assist providers in personalizing glycemic targets.
- Diabetes Mellitus, Type 2/therapy
- Hemoglobin A.Glycosylated
- Aged
- Primary Health Care
- Cross-Sectional studies
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Footnotes
Contributors MJC and MG contributed to the conception and design. BA was responsible for the acquisition of data. CM, BA and RM contributed substantially to the analysis of data. CHY provided content-specific expertise on diabetes. MJC and MG drafted the initial version of the article. All authors contributed to the interpretation of data. All authors reviewed and revised the article for important intellectual content and gave final approval of the version to be published. MG is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Funding The Canadian Primary Care Sentinel Surveillance Network was a committee of the College of Family Physicians of Canada and was funded through a contribution agreement with the Public Health Agency of Canada.
Disclaimer The views expressed herein do not necessarily represent the views of the Public Health Agency of Canada.
Competing interests MG holds an investigator award from the Department of Family and Community Medicine, University of Toronto.
Patient consent This is an observational study with no patient intervention and no patient identification.
Ethics approval University of Toronto.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Data are from a nationally representative Canadian repository of primary care electronic medical record data, the Canadian Primary Care Sentinel Surveillance Network (CPCSSN, cpcssn.ca). CPCSSN data are available to researchers as outlined in the process available on the website.
Correction notice This paper has been amended since it was published Online First. Owing to a scripting error, some of the publisher names in the references were replaced with 'BMJ Publishing Group'. This only affected the full text version, not the PDF. We have since corrected these errors and the correct publishers have been inserted into the references.