Major gaps in diabetes clinical care among Canada's First Nations: results of the CIRCLE study

Diabetes Res Clin Pract. 2011 May;92(2):272-9. doi: 10.1016/j.diabres.2011.02.006. Epub 2011 Mar 3.


Aims: The aim of this cross-sectional study was to document the clinical management of type 2 diabetes and related complications in Canada's First Nations.

Methods: Patients were randomly selected from 19 communities. Data from charts from consenting patients were collected.

Results: Of 885 patients, 63.3% were female, mean age was 54.9 years and mean duration of T2DM was 11.2 years. Mean A1C was 8.2%; 61.1% of patients had an A1C >7.0%; mean LDL was 2.4 mmol/L; 92.6% had dyslipidemia; mean systolic BP was 132 mm Hg; mean diastolic BP was 76 mm Hg; 92.0% had hypertension. Lipid-lowering medications were prescribed to 62.9% of those with dyslipidemia and an LDL-C >2.0 mmol/L. Of hypertensive patients, 15.8% were not on an antihypertensive agent. For vascular protection, 55.1% were on a statin, 72.1% on an ACE inhibitor or ARB, and 64.5% on an anticoagulant. Smoking was documented in 39.4%, 92.1% were overweight/obese; 55.1% had chronic kidney disease, and 13.3% had coronary artery disease.

Conclusions: Major care gaps were revealed, with most patients not achieving glycemic, lipid and BP targets. Over half of this relatively young cohort had established microvascular disease. Macrovascular disease rates may increase dramatically due to the high prevalence of risk factors.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antihypertensive Agents / therapeutic use
  • Blood Pressure / drug effects
  • Body Mass Index
  • Canada / epidemiology
  • Cross-Sectional Studies
  • Diabetes Mellitus, Type 2 / epidemiology*
  • Female
  • Humans
  • Hypertension / complications
  • Indians, North American
  • Kidney Diseases / complications
  • Male
  • Middle Aged
  • Risk Factors
  • Smoking / adverse effects


  • Antihypertensive Agents