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Poor lipid control in type-2 diabetics with and without ischemic heart disease
Daad H Akbar1, Aish A Al-Gamdi, Nariman A Hejazi
1Department of Medicine, King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia. daadakb@yahoo.com
Insights
Type-2 diabetics often have uncontrolled lipoprotein levels, even with cardiovascular risks. Poor diet and multiple medications contribute to this, highlighting the need for better diabetes management in elderly patients.
Area of Science:
- Cardiology
- Endocrinology
- Metabolic Disorders
Background:
- Type-2 diabetes mellitus (T2DM) is a significant global health concern.
- Lipoprotein dysregulation is common in T2DM and a major risk factor for cardiovascular disease (CVD).
- Effective management of lipid profiles is crucial for preventing diabetic complications.
Purpose of the Study:
- To assess the prevalence of target lipoprotein levels in type-2 diabetic patients.
- To investigate lipid profiles in diabetic patients with ischemic heart disease (IHD) and other CVD risk factors.
- To identify factors contributing to poor glycemic and lipid control.
Main Methods:
- Retrospective review of hyperlipidemic type-2 diabetic patients at King Abdulaziz University Hospital (Jan 2000-Jan 2001).
- Analysis of lipid levels (LDL, HDL, TG) and their achievement of target ranges.
- Evaluation of associated risk factors, comorbidities, and reasons for poor control.
Main Results:
- A low frequency of patients achieved target LDL (< 2.6 mmol/L), HDL (> 1.1 mmol/L), and TG (< 1.7 mmol/L) levels (31%, 28%, 37% respectively).
- No significant difference in target LDL levels was observed between patients with and without IHD or other CVD risk factors (hypertension, obesity, family history).
- Males showed a higher frequency of achieving target LDL compared to females (38% vs 25%, p=0.04).
- Poor diet compliance (90%), lack of patient knowledge (62%), financial issues (70%), and polypharmacy (86%) were associated with poor control.
Conclusions:
- Type-2 diabetics, including those with IHD and CVD risk factors, frequently exhibit suboptimal lipoprotein control.
- Poor adherence to diet and the use of multiple medications are significant contributors to inadequate lipid management.
- Enhanced patient education, adherence support, and physician vigilance are essential for improving outcomes in this population.
Abstract:
To determine the frequency of type-2 diabetics who have target lipoprotein blood levels, to study these levels in patients with ischemic heart disease and cardiovascular disease risk factors, and to study the possible causes of poor control, we reviewed hyperlipdemic type-2 diabetics who were on regular follow up to the medical outpatient clinic of King Abdulaziz University Hospital from January 2000 to January 2001. A total of 202 patients were studied with mean age of 60 yr and equal male to female ratio. The mean duration of diabetes was 10 yr and it was 7 yr for hyperlipidemia. The mean level of LDL was 3.15 mmol/L and it was 1.0 mmol/L and 2.47 mmol/L for HDL and TG, respectively. Only 31% of patients had LDL < 2.6 mmol/L, 28% had HDL > 1.1 mmol/L, and 37% had TG < 1.7 mmol/L. No significant difference was found in the frequency of target level of LDL in patients with IHD and those without; 26% vs 34% (0.4). Similarly, no difference was found in those with hypertension, obesity, and patients with family history of IHD compared to those without these risk factors; 30%, 26%, 16% vs 34%, 36%, 33% (p = 0.2, 0.1, 0.4, respectively). Males were found to have a higher frequency of target LDL level compared to females; 38% vs 25% (p = 0.04). Poor diet restriction was found in 90% of patients' with poor control, lack of patients' knowledge in 62%, 70% have financial reasons, 86% of patients on multiple medications, and in 16% the treating physician took no proper action. In conclusion, a low frequency of type-2 diabetics have target levels of lipoproteins. Diabetics with IHD and CVD risk factors also have poor lipid control. Poor control was associated with poor diet compliance and use of multiple medications. Proper management and control of this disease is needed among elderly patients.
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