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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 MembersWestern Canada:

Lori Berard, RN, CDE – Nurse and Certified Diabetes Educator – Winnipeg, MBKeith Bowering, MD – Endocrinologist – Edmonton, ABKeith Dawson, MD – Endocrinologist – Vancouver, BCRoss Tsuyuki, PharmD – Academic Pharmacist – Calgary ABVincent Woo, MD – Endocrinologist – Winnipeg, MB

Ontario:Alice Cheng, MD – Endocrinologist – Toronto, ONStewart Harris, MD – Primary Care Physician/Diabetes Expert – London, ONAnatoly Langer MD – Cardiologist – Toronto, ONLawrence Leiter, MD (Chair) – Endocrinologist – Toronto, ONPeter Lin, MD – Primary Care Physician – Toronto, ONDana Whitham, RD, MSc, CDE – Dietitian and Certified Diabetes Educator – Toronto, ON

Quebec:Jean-Marie Ekoé, MD – Endocrinologist – Montreal, QCCarl Fournier, MD – Primary Care Physician – Montreal, QC Jean-Francois Yale, MD – Endocrinologist – Montreal, QC

Atlantic Canada:Thomas Ransom, MD – Endocrinologist – Halifax, NS

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 OverviewAssess 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)

National Physician and Patient Representation

ABMDs – n=29DCFs – n=233

BCMDs – n=41 DCFs – n=365

MBMDs – n=19 DCFs – n=249

SKMDs – n=3 DCFs – n=21

ONMDs – n=270

DCFs – n=2990

QCMDs – n =45 DCFs – n=400

NB-PEIMDs – n=27 DCFs – n=362

NSMDs – n=28 DCFs – n=295

NLMDs – n=17

DCFs – n=208

MDs – N = 479DCFs – N = 5123• Avg. number of DCF*s/MD - 11

* DCF – Data Collection Form

Practice Setting

41%

59%

Solo PracticeGroup Practice

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

Physician Practice – Geographic Setting

16%

21%63%

Inner CitySmall Town / RuralUrban / Suburban

Practice Survey Question:On average, how many patients with Type 2 Diabetes

do you see in a week?

Number of patients % - physician responses

Less than 5 1%

5 to 10 13%

10 to 20 36%

20 to 30 27%

30 to 50 16%

More than 50 7%

Percent of patients % - physician responses

None 3%

1 to 25% 56%

26 to 50% 19%

> 50% 22%

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:

Top Five Responses:

1. Patient non-compliance2. Patient resistance3. Constraints on physician’s time4. Financial barriers5. Lack of support for the physician

Patient Demographics

* Data presented as mean (SD)Female Sex: n=2353 Available Records 4707Age: n=5090Duration of T2DM: n=5062

46%Age* 64 (12)

Duration of T2DM* 9 (7)

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

Patient Ethnicity

Aboriginal Canadian 3%

Black 4%

Caucasian 61%

East / SE Asian 17%

Hispanic 2%

South Asian 11%

Other 3%

N = 4971

152 records unavailable


Summary of Patient BMI Categories

Category Percent of Patients

Normal Weight 14%

Overweight 29%

Obese 57%

Body Mass Index (kg/m2) Mean (SD)Men 30.5 (10)Women 31.1 (11.6)

N = 5123*

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


Health Behaviours

38% of patients had been referred to or counselled by a registered dietitian or a certified diabetes educator within the last 12 months (n=4787)

50% of patients had a nutrition / exercise / weight loss plan with measurable goals established in the past 12 months (n=4776)


Glycemic and Renal Profile

Measure N Mean + SD Guideline Recommendations

A1C (%) 5103 7.4 + 1.3 <7.0%

Fasting Plasma Glucose (mmol/L) 4761 7.8 + 2.6 4.0 – 7.0

Creatinine (µmol/L) 4890 86 + 124 N / A

eGFR (mL/min) 4615 75.2 + 44.1 N / A

Urine Albumin Creatinine Ratio (mg/mmol) 3957 10.7 + 48.4 <2.0 (men) <2.8 (women)


Insulin Use by Number of Injections per Day

1 Injection / day 2 injections / day 3 injections / day 4 injections / day > 4 injections / day0%

20%

40%

60%

9%

29%

15%

40%

7%

28% 28%

13%

27%

5%

Insulin Only Insulin + NIAHA*

% o

f pati

ents

* NIAHA – Non Insulin Antihyperglycemic Agent


Glycemic Management

N = 4477

Medical Management N % of Patients

1 NIAHA* - 85% treated with Metformin 802 18%

2 NIAHAs 673 15%

≥ 3 NIAHAs 261 6%

Insulin alone 854 19%

Insulin + ≥ 1 NIAHAs 1887 42%

* NIAHA - non-insulin antihyperglycemic agent


A1C Values AchievedN = 5103

Target Achieved ≤6.5%

Target Achieved ≤7.0%

≤7.5% ≤8% ≤8.5% ≤ 9.0%0%

20%

40%

60%

80%

100%

28%

50%

67%

78%

86%91%

% o

f pati

ents

A1C (%)


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

A1C <7% Attainment Rates based on Duration of Diabetes

≤2 years 3-5 years 6-9 years 10-14 years >15 years0%

20%

40%

60%

80%

65%

58%

49%

43%

37%

Duration of Diabetes (years)

% o

f pati

ents

– A

1C <

7%


Lipid Profile

N = 5069

Measure Mean + SD Guideline Recommendations

LDL 2.1 + 0.9 <2.0 mmol/L


Lipid Management

Management % of Patients

Monotherapy 88%

Statin alone 85%

2 Lipid Lowering Agents 11%

Statin + Cholesterol Absorption Inhibitor 8%

> 2 Lipid Lowering Agents <1%

N = 4153


LDL-C Values Achieved

N = 5069

Target Achieved ≤2.0 ≤2.5 ≤3.0 ≤3.50%

20%

40%

60%

80%

100%

57%

75%

86%

93%

% o

f pati

ents

LDL-C (mmol/L)


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


Lipid Control and Management of DM-SCAN Patients


Blood Pressure Profile

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

Measure Mean + SD Guideline Recommendations

SBP 128 + 14 < 130 mm Hg

DBP 75 + 9 < 80 mm Hg


Blood Pressure Management

N = 4946Management % of Patients

BP recorded (Nov / Dec 2012) 70%

Not treated with BP medication 17%

N = 4272Monotherapy 39%

2 Agents 34%

3 Agents 21%

3+ Agents 6%


Blood Pressure Values AchievedN = 5099

Target Achieved SBP < 130 / DBP < 80

<135 / <85 <140 / <90 <145 / <95 <150 / <1000%

20%

40%

60%

80%

100%

36%

69%

79%

90%93%

% o

f pati

ents

SBP / DBP (mm Hg)


Distribution of Antihypertensive Therapy Strategies Prescribed to Patients with Blood

Pressure >130/80 mmHg

N = 1494


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

A1C (≤7%) (n=5103) LDL-C (≤2.0 mmol/L) (n=5069)

SBP/DBP (<130/80 mm HG) (n=5099)

All 3 Endpoints (A1C, LDL-C,

BP) (n=5104)

0%

20%

40%

60%

50%

57%

36%

13%

% o

f pati

ents


Patient Comorbidities

Depression

Cancer

Erectile Dysfunction (n=2313)

Neuropathy

Nephropathy

Retinopathy

Atrial Fibrillation

PAD

Stroke / TIA

CAD

0% 20% 40% 60%

12%

12%

39%

12%

15%

8%

7%

8%

6%

22%

% of patients


Has glycemic management improved over the last decade?

DICE(2002-2003)

N = 2473

DRIVE(2005-2006)

N = 3002

DM-SCAN(Nov-Dec 2012)

N=5123

Age at audit, years 62.7 63 64

Time since diagnosis, years 7.8 8.1 9.2

Female, % 46 41 46

BMI, kg/m2 31 31 31

A1C, % 7.3 7.2 7.4

A1C >7.0%, proportion of patients 49 47 50

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.

Note: All data reported as mean

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