Achievement of treatment targets among patients with type 2 diabetes in 2015 and 2020 in Canadian primary care

Nandiwada, Shiva; Manca, Donna; Yeung, Roseanne O.; Lau, Darren

doi:10.1503/cmaj.220673

Cited by 9 publications

(5 citation statements)

References 48 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although the management of type 2 DM has improved sub stantially in recent decades, patients with diabetes in China are still at substantial risk of kidney disease and progressive loss of renal function. Our study found that only 36.6% of people with type 2 DM who were age 40 years or older were prescribed statins during the study period, which is lower than that in Canada (54.0% for males and 45.3% for females) 62 and the United States (41.6%). 63 The current national guideline in China recommends statin therapy for patients with diabetes who are aged 40 years or older.…”

Section: Discussioncontrasting

confidence: 61%

Statin initiation and risk of incident kidney disease in patients with diabetes

Zhou

Ling²,

Xu³

et al. 2023

CMAJ

View full text Add to dashboard Cite

Statins are among the most commonly prescribed medica tions, administered to 146 million people worldwide. 1 Statin therapy reduces the risk of cardiovascular disease in patients with type 2 diabetes mellitus (DM) and in patients with hyper tension. [2][3][4][5] Current guidelines from the Canadian Cardiovascu lar Society and the American Diabetes Association recommend statin therapy for patients with diabetes aged 40 years or older. [6][7][8][9] However, some recent studies have shown that treat ment with a statin alters glucose metabolism and affects gly cemic control in such patients. [10][11][12][13][14][15] Given that a worsening of glycemic control is associated with the development or pro gression of microvascular disease, 16 patients with diabetes who are undergoing statin treatment might be at higher risk of developing microvascular complications.

show abstract

Section: Discussioncontrasting

confidence: 61%

Statin initiation and risk of incident kidney disease in patients with diabetes

Zhou

Ling²,

Xu³

et al. 2023

CMAJ

View full text Add to dashboard Cite

show abstract

“…The benefit of statin therapy for primary CV prevention is well established, yet the proportion of adults with diabetes taking a statin has plateaued 1 . Although current guidelines treat diabetes uniformly, a spectrum of CV risk exists, which can be quantified and visualized by CAC scanning.…”

Section: Discussionmentioning

confidence: 99%

“…Many adults with diabetes are not on a statin 1 . A coronary artery calcium (CAC) scan provides a depiction of coronary artery disease and is predictive of cardiovascular (CV) risk.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Personalizing cardiovascular risk: Coronary artery calcium scans to improve statin use in adults with type 2 diabetes can be cost‐effective in select individuals

Lau,

Pearson,

Raggi

et al. 2024

Diabetes Obesity Metabolism

Self Cite

View full text Add to dashboard Cite

BACKGROUNDMany adults with diabetes are not on a statin. 1 A coronary artery calcium (CAC) scan provides a depiction of coronary artery disease and is predictive of cardiovascular (CV) risk. Showing and discussing CAC scan findings with patients has been shown to increase the use of preventive medications. 2,3 Even in trials where CAC-based intervention reduced the use of statins (e.g., due to enrolment of healthier individuals at lower CV risk), the distribution of statin use shifted toward higher-risk individuals, 4 with overall reductions in CV risk. 2 CAC scans may be considered a form of personalized medicine, with incremental utility dependent on judicious patient selection. 5,6 Guidelines recommend the use of CAC scans in intermediate-risk individuals to help decide whether to start statin therapy. Since

show abstract

“…55 Clinical research has identified strategies to reduce the morbidity and mortality of diabetes-related complications and summarized into clinical practice guidelines (here forth referred to as "guidelines"). Despite the publication and dissemination of guidelines over the past 30 years, the percentage of patients receiving guideline-recommended care remains low, 56,57 a problem characterized as "clinical inertia"-recognition by a health care professional of a problem with a patient but a failure to act. 58 In response, the clinical diabetes literature and professional organizations have prioritized the need to develop interventions to address and overcome clinical inertia, most notably in family medicine settings where most patients are seen.…”

Section: Supplementing the Framework Approach With A Postmodernist Th...mentioning

confidence: 99%

Rethinking Context in Continuing Professional Development: From Identifying Barriers to Understanding Social Dynamics

Wong,

Kitto

2023

J Contin Educ Health Prof

View full text Add to dashboard Cite

Introduction: For continuing professional development (CPD) to reach its potential to improve outcomes requires an understanding of the role of context and the influencing conditions that enable interventions to succeed. We argue that the heuristic use of frameworks to design and implement interventions tends to conceptualize context as defined lists of barriers, which may obscure consideration of how different contextual factors interact with and intersect with each other. Methods: We suggest a framework approach that would benefit from postmodernist theory that explores how ideologies, meanings, and social structures in health care settings shape social practices. As an illustrative example, we conducted a Foucauldian discourse analysis of diabetes care to make visible how the social, historical, and political conditions in which clinicians experience, practice, and shape possibilities for behavior change. Results: The discursive construction of continuing education as a knowledge translation mechanism assumes and is contingent on family physicians to implement guidelines. However, they enact other discursively constituted roles that may run in opposition. This paradoxical position creates a tension that must be navigated by family physicians, who may perceive it possible to provide good care without necessarily implementing guidelines. Discussion: We suggest marrying “framework” thinking with postmodernist theory that explores how ideologies, meanings, and social structures shape practice behavior change. Such a proposed reconceptualization of context in the design of continuing professional development interventions could provide a more robust and nuanced understanding of how the dynamic relationships and interactions between clinicians, patients, and their work environments shape educational effectiveness.

show abstract

Achievement of treatment targets among patients with type 2 diabetes in 2015 and 2020 in Canadian primary care

Cited by 9 publications

References 48 publications

Statin initiation and risk of incident kidney disease in patients with diabetes

Statin initiation and risk of incident kidney disease in patients with diabetes

Personalizing cardiovascular risk: Coronary artery calcium scans to improve statin use in adults with type 2 diabetes can be cost‐effective in select individuals

Rethinking Context in Continuing Professional Development: From Identifying Barriers to Understanding Social Dynamics

Contact Info

Product

Resources

About