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Many elderly diabetes patients not receiving recommended drugs


The Institute for Clinical Evaluative Sciences (ICES) has found that many Ontario seniors with diabetes are not being prescribed important medications to help control high blood pressure and cholesterol levels, sometimes even when they are under the care of diabetes specialists such as endocrinologists.

“Although it has been proposed that physician specialty influences the likelihood of diabetes patients receiving vascular risk modification medications, there have been no large population-based studies on this issue that have been able to detect prescribing differences between physician groups,” said study lead author and ICES scientist Dr. Baiju Shah.

In order to conduct a broader population-based examination of this topic, investigators tracked over 105,000 Ontarians aged 65 and older with newly-diagnosed diabetes between 1994 and 2001. They compared receipt of anti-hypertensive and lipid-lowering drugs between patients who had regular care from endocrinologists, internists/geriatricians and family physicians.

The results showed that, overall, only two-thirds of elderly diabetes patients received anti-hypertensive drugs and about one-quarter received lipid-lowering drugs. Compared to patients of family physicians, those seeing internists or geriatricians were 27% more likely to receive anti-hypertensive drugs and those seeing endocrinologists were 58% more likely to receive lipid-lowering drugs.

However, anti-hypertensive drug use among endocrinologists’ patients did not differ from family physicians’ patients, even though hypertension control is the component of diabetes management that has the greatest evidence of benefit to patients, and also has been shown to reduce costs to the healthcare system.

“Our results highlight deficiencies in the use of vascular risk modifying medications among diabetes patients,” said Dr. Shah.

“Although vascular disease accounts for the majority of deaths of people with diabetes, important high blood pressure and cholesterol risk factors were not adequately treated according to our study. Greater emphasis on risk factor management is needed through educational interventions and patient care tools for clinicians.

“It’s important to remember that diabetes management goes beyond controlling blood sugar levels; blood pressure and cholesterol management is an integral part of care to diabetes patients and critical to reducing morbidity and mortality.”

The study, “Use of vascular risk-modifying medications for diabetic patients differs between physician specialties”, is in the October 2006 issue of the journal Diabetic Medicine.

Author affiliations: ICES (Drs. Shah, Hux, Laupacis, and Booth); Department of Medicine, University of Toronto (all authors); Sunnybrook Health Sciences Centre (Drs. Shah, Hux, and Laupacis); Leadership Sinai Centre for Diabetes, Mount Sinai Hospital (Dr. Zinman); St. Michael’s Hospital (Drs. Laupacis and Booth).

ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy.


  • Julie Dowdie
  • Media Relations Officer, ICES
  • (416) 480-4780 or cell (416) 432-8143


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