Cholesterol management of patients with diabetes in a primary care practice-based research network

To determine the proportion of diabetic patients with and without coronary heart disease (CHD) who attained the American Diabetes Association recommended low-density lipoprotein cholesterol (LDL-C) target level of < or = 2.60 mmol/L (< or = 100 mg/dL).

Retrospective cross-sectional study.

Patients were identified by searching an electronic medical record database from March 1997 through March 2001. Search strategies included a problem list entry of diabetes mellitus or CHD, a medication in the antidiabetic or nitrate class, or a glycosylated hemoglobin value of > or = 7.0%. Additional information included patient demographics, last LDL-C level, and use of a lipid-lowering agent.

The study identified 10,201 patients (4844 with diabetes only, 1243 with diabetes plus CHD, and 4114 with CHD only). A greater proportion of patients who had diabetes and CHD attained the LDL-C target goal compared with patients who had diabetes only (32.1% vs 18.1%; P < .001). Furthermore, patients with diabetes plus CHD were more likely to have a LDL-C level measured within the past year (50.2% vs 42.5% respectively; P < .001). Multivariate logistic regression analysis revealed several factors associated with LDL-C goal attainment, including prior history of CHD, lipid-lowering therapy, tight glycemic control, HMO insurance, and a family medicine provider.

Although LDL-C goal attainment in patients with diabetes plus CHD was significantly better than that in patients with diabetes only, the prevalence of inadequate control in these high-risk populations is of national concern.