Life expectancy for over 2 million Canadians with type 2 diabetes mellitus is shortened by 5-10 years (2). The leading cause of death in this population is heart disease and stroke which account for approximately 65% of deaths (3).
In addition to an increased risk of cardiovascular morbidity and mortality, type 2 diabetes represents the cause of 33% of end stage kidney disease (2002). This is a 22% increase from 1990 and a number that is expected to continue to rise (5). The risk of diabetic microalbuminuria or worsening nephropathy in type 2 diabetes is modelled to be approximately 28% after 15 years (6). The number of new patients starting dialysis each year in Canada (2002) is 4961. This number has doubled in the last decade (7). According to Canadian statistics, between 1991and 2000, 70% of patients die within 10 years of starting dialysis. Patients with diabetes and cardiovascular disease upon starting dialysis are twice as likely to die within this time frame (8).
There is a need for interventions that can reduce the risk of morbidity and mortality associated with type 2 diabetes and its complications, particularly those of cardiovascular and kidney disease.
Study Design: Prospective randomized-controlled 3-year pilot study
Population: New Brunswickers, 18 years of age and older, with Type 2 Diabetes currently registered as a patient of one of 40 participating general physician’s offices in New Brunswick.
Hypothesis: Implementation of a multi-system disease management model integrating electronic feedback for general practitioners and quick access to a multidisciplinary specialist team will demonstrate a statistically significant improvement in achieving target primary outcomes consisting of BP 130/80, Slowing of GFR decline (ml/min/yr) and HgbA1C <7%
Primary Outcomes: Reduction in blood perssure, reduction of GFR decline (ml/min/yr) and reduction in AIC
Secondary Outcomes: LDL cholesterol, development of overt nephropathy, doubling of serum creatinine or dialysis, all cause mortality, resource utilization, projected economic cost avoidance, user satisfaction (physician, patient)