Glycaemic control and cardiovascular risk factor management in patients with diabetes with and without coronary artery disease: insights from the diabetes mellitus status in Canada survey

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Abstract
Aims Current diabetes guidelines recommend an individualized approach to glycemic control. There are limited data on the contemporary and comprehensive management of patients with diabetes in relation to coronary artery disease (CAD). Methods and Results The Diabetes Mellitus Status in Canada survey included 5123 patients with type 2 diabetes seen in primary care in November 2012. Primary care physicians (PCPs) collected clinical data and specified the A1C target for each patient on standardized forms. We compared management strategies and achievement of treatment targets in patients with and without CAD. Among the 4994 patients with data on CAD history, 22.5% had CAD. PCPs were more likely to select a higher A1C target for patients with CAD (≤7.5% or ≤8.0%) versus without (≤7.0%). There was no difference in median A1C or in the proportion of patients with A1C ≤7.0% between the 2 groups. Compared to the group without known CAD, patients with CAD had a higher reported prevalence of hypoglycemia in the preceding 6 months; more frequently received aspirin, statins, ACE inhibitors or angiotensin receptor blockers, and were more likely to achieve blood pressure and LDL-C targets. Only 15.4% and 12.0% of patients with and without CAD (p=0.002), respectively, achieved all three guideline-recommended targets. Conclusion Compared to patients with diabetes without CAD, those with CAD more frequently had a less stringent A1C target selected by their primary care physicians but achieved similar glycemic control. Overall, risk factor management remained suboptimal in both groups. There remains an important opportunity to improve the care and outcome of patients with diabetes.
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