The study, published in the Canadian Medical Association Journal, revealed significant treatment gaps for people with type 2 diabetes (the type most associated with obesity and older age), who also had symptoms of hardening of the arteries.
While patients were all being treated for high blood sugar, less than 25 per cent were on medication needed to control high cholesterol and less than 50 per cent were receiving medication to treat high blood pressure. Both conditions are common in people with type 2 diabetes and can lead to fatal strokes and heart attacks.
The cardiovascular risks that accompany diabetes tend to take a back seat to the issue of controlling blood sugar, but are just as vital, Dr. Johnson said. "There is a 'glucocentric' view of diabetes, and our study shows that people with Type 2 diabetes are not being optimally managed for their cardiovascular risk."
"Seventy per cent of people with Type 2 diabetes die of heart attack and stroke. If we keep paying attention to blood sugar, we're missing a big piece of the picture," warned Dr. Jeffrey Johnson, a professor and researcher of Public Health Sciences at the University of Alberta, and one of the authors on the paper.
More disturbing was the discovery that fewer than 10 per cent who had undergone lower limb amputations related to their diabetes were on heart medications, Johnson said. "Having an amputation indicates an extreme severity and an increased risk of stroke and heart attack. The use of heart medication should be higher, but it is very low, so attention is not being paid to the cardiovascular risk."
The University of Alberta study involved using administrative records from a provincial health department to evaluate the use of such treatments as antiplatelet agents and statins in 12,106 patients with type 2 diabetes. All of the people identified in the study were on medications for high blood sugar, but few were taking medications for heart disease.
There were a reported 2.2 million Canadians living with diabetes in 2002, of whom 90 per cent had type 2 diabetes.
More programs need to be developed to improve the quality of cardiovascular risk reduction in high-risk diabetes patients, Dr. Johnson said.
"It is really a problem of the way our health care systems deal with chronic medical conditions that require prevention, such as healthy lifestyles or medications that can reduce the risk of heart attacks and strokes," Dr. Johnson said. "Our primary health care system needs support to help identify people who need this preventive care, and then to follow their care into the future."
The study was funded in part by the Alberta Heritage Foundation for Medical Research, the Canadian Diabetes Association, the Heart and Stroke Foundation of Canada, the Kidney Foundation of Canada and the Canadian Institutes of Health Research.
Journal
Canadian Medical Association Journal