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www.dmscan.ca. The DM-SCAN program has been made possible through the support of Merck Canada Inc. The opinions expressed in this material are those of the authors and do not necessarily reflect the views of Merck Canada Inc . Steering Committee Members Western Canada:

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Www dmscan ca

www.dmscan.ca

The DM-SCAN program has been made possible through the support of Merck Canada Inc.

The opinions expressed in this material are those of the authors and do not necessarily reflect the views of Merck Canada Inc.


Www dmscan ca

  • Steering Committee Members

  • Western Canada:

    • Lori Berard, RN, CDE – Nurse and Certified Diabetes Educator – Winnipeg, MB

    • Keith Bowering, MD – Endocrinologist – Edmonton, AB

    • Keith Dawson, MD – Endocrinologist – Vancouver, BC

    • Ross Tsuyuki, PharmD – Academic Pharmacist – Calgary AB

    • Vincent Woo, MD – Endocrinologist – Winnipeg, MB

  • Ontario:

    • Alice Cheng, MD – Endocrinologist – Toronto, ON

    • Stewart Harris, MD – Primary Care Physician/Diabetes Expert – London, ON

    • Anatoly Langer MD – Cardiologist – Toronto, ON

    • Lawrence Leiter, MD (Chair) – Endocrinologist – Toronto, ON

    • Peter Lin, MD – Primary Care Physician – Toronto, ON

    • Dana Whitham, RD, MSc, CDE – Dietitian and Certified Diabetes Educator – Toronto, ON

  • Quebec:

    • Jean-Marie Ekoé, MD – Endocrinologist – Montreal, QC

    • Carl Fournier, MD – Primary Care Physician – Montreal, QC

    • Jean-Francois Yale, MD – Endocrinologist – Montreal, QC

  • Atlantic Canada:

    • Thomas Ransom, MD – Endocrinologist – Halifax, NS


Program objectives

Program Objectives

  • To evaluate and gain insight into the current status and management of patients with Type 2 Diabetes in Canada in the primary care setting

  • To highlight the public health burden of Type 2 Diabetes

  • To identify management gaps to help design educational programs of practical value to primary care physicians


Program overview

Program Overview

Assess the current management of patients with type 2 diabetes by completing a simple one-page Data Collection Form on ALL patients seen as part of routine clinical practice on or as close as possible to World Diabetes Day (November 14, 2012)


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National Physician and Patient Representation

MDs – N = 479

DCFs – N = 5123

  • Avg. number of DCF*s/MD - 11

NL

MDs – n=17

DCFs – n=208

BC

MDs – n=41

DCFs – n=365

AB

MDs – n=29

DCFs – n=233

SK

MDs – n=3

DCFs – n=21

MB

MDs – n=19

DCFs – n=249

QC

MDs – n =45

DCFs – n=400

ON

MDs – n=270

DCFs – n=2990

NS

MDs – n=28

DCFs – n=295

NB-PEI

MDs – n=27

DCFs – n=362

* DCF – Data Collection Form


Practice setting

Practice Setting

50% of the physician participants identified being a part of a Family Health Team


Physician practice geographic setting

Physician Practice – Geographic Setting


Practice survey question on average how many patients with type 2 diabetes do you see in a week

Practice Survey Question:On average, how many patients with Type 2 Diabetes do you see in a week?


Www dmscan ca

Practice Survey Question:Approximately what proportion of your patients have their type 2 diabetes co-managed by an allied health care professional (in your office or local diabetes education centre)?


Practice survey question please identify the greatest barriers to managing patients with diabetes

Practice Survey Question:Please identify the greatest barriers to managing patients with diabetes:

Top Five Responses:

Patient non-compliance

Patient resistance

Constraints on physician’s time

Financial barriers

Lack of support for the physician


Patient demographics

Patient Demographics

Female Sex: n=2353 Available Records 4707

Age: n=5090

Duration of T2DM: n=5062

* Data presented as mean (SD)

L.A. Leiter et al. / Can J Diabetes 37 (2013) 82-89


Patient ethnicity

Patient Ethnicity

N = 4971

152 records unavailable

L.A. Leiter et al. / Can J Diabetes 37 (2013) 82-89


Summary of patient bmi categories

Summary of Patient BMI Categories

N = 5123*

N for each category was variable due to missing values, <10% in each case.

L.A. Leiter et al. / Can J Diabetes 37 (2013) 82-89


Health behaviours

Health Behaviours

L.A. Leiter et al. / Can J Diabetes 37 (2013) 82-89


Glycemic and renal profile

Glycemic and Renal Profile

L.A. Leiter et al. / Can J Diabetes 37 (2013) 82-89


Insulin use by number of injections per day

Insulin Use by Number of Injections per Day

% of patients

* NIAHA – Non Insulin Antihyperglycemic Agent

L.A. Leiter et al. / Can J Diabetes 37 (2013) 82-89


Glycemic management

Glycemic Management

N = 4477

* NIAHA - non-insulin antihyperglycemic agent

L.A. Leiter et al. / Can J Diabetes 37 (2013) 82-89


A1c values achieved

A1C Values Achieved

N = 5103

% of patients

A1C (%)

In 81% of patients, the A1C goal set by the physicians was ≤7%.

L.A. Leiter et al. / Can J Diabetes 37 (2013) 82-89


A1c 7 attainment rates based on duration of diabetes

A1C <7% Attainment Rates based on Duration of Diabetes

L.A. Leiter et al. / Can J Diabetes 37 (2013) 82-89


Lipid profile

Lipid Profile

N = 5069

L.A. Leiter et al. / Can J Diabetes 37 (2013) 82-89


Lipid management

Lipid Management

N = 4153

L.A. Leiter et al. / Can J Diabetes 37 (2013) 82-89


Ldl c values achieved

LDL-C Values Achieved

N = 5069

% of patients

LDL-C (mmol/L)

L.A. Leiter et al. / Can J Diabetes 37 (2013) 82-89


Ldl c values achieved presence and absence of vascular disease

LDL-C Values Achieved – Presence and Absence of Vascular Disease

L.A. Leiter et al. / Can J Diabetes 37 (2013) 82-89


Lipid control and management of dm scan patients

Lipid Control and Management of DM-SCAN Patients

L.A. Leiter et al. / Can J Diabetes 37 (2013) 82-89


Blood pressure profile

Blood Pressure Profile

Systolic Blood Pressure: N = 5103, Diastolic Blood Pressure: N = 5099

L.A. Leiter et al. / Can J Diabetes 37 (2013) 82-89


Blood pressure management

Blood Pressure Management

N = 4946

L.A. Leiter et al. / Can J Diabetes 37 (2013) 82-89


Blood pressure values achieved

Blood Pressure Values Achieved

N = 5099

% of patients

SBP / DBP (mm Hg)

L.A. Leiter et al. / Can J Diabetes 37 (2013) 82-89


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Distribution of Antihypertensive Therapy Strategies Prescribed to Patients with Blood Pressure >130/80 mmHg

N = 1494

L.A. Leiter et al. / Can J Diabetes 37 (2013) 82-89


Guideline targets achieved for a1c ldl c and blood pressure

Guideline Targets Achieved for A1C, LDL-C and Blood Pressure

% of patients

L.A. Leiter et al. / Can J Diabetes 37 (2013) 82-89


Patient comorbidities

Patient Comorbidities

% of patients

L.A. Leiter et al. / Can J Diabetes 37 (2013) 82-89


Has glycemic management improved over the last decade

Has glycemic management improved over the last decade?

Note: All data reported as mean

1Harris S, et al. Diabetes Res Clin Prac. 2005;70(1):90-97.

2Braga M, et al. Can J Cardiol. 2010;26(6):297-302.


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