Compliance with recommendations for lipid management among patients with type 2 diabetes in an academic family
Gavin Putzer1, Richard Roetzheim, Arnold M Ramirez
1Department of Family Medicine, University of South Florida, Tampa, FL 33612, USA.
Insights
Most patients with type 2 diabetes do not meet American Diabetes Association (ADA) lipid goals for high-density lipoprotein (HDL), low-density lipoprotein (LDL), and triglycerides. This highlights a significant gap in managing cardiovascular risk factors in diabetic populations.
Area of Science:
- Cardiology
- Endocrinology
- Public Health
Background:
- Lipid abnormalities are prevalent in type 2 diabetes, increasing cardiac disease risk.
- The American Diabetes Association (ADA) established lipid treatment goals: HDL >45 mg/dL, triglyceride <200 mg/dL, LDL <100 mg/dL.
- Attainment of these ADA lipid goals in primary care settings for diabetic patients is not well-documented.
Purpose of the Study:
- To assess the frequency of achieving ADA lipid goals in patients with type 2 diabetes.
- To identify clinical predictors associated with lipid goal attainment in this population.
Main Methods:
- A chart review was conducted on 239 randomly selected patients with type 2 diabetes.
- Logistic regression analysis was used to examine predictors of lipid goal attainment.
Main Results:
- Only 42.0% achieved HDL goals, 47.0% achieved LDL goals, and 70.0% achieved triglyceride goals.
- A mere 14.6% of patients met all three ADA lipid targets.
- Predictors for LDL goal attainment included male gender, lipid-lowering drug use, and hypertension; HDL goal attainment was associated with female gender, black race, lower BMI, and lower triglycerides; triglyceride goal attainment was linked to male gender, dual insurance, and higher HDL levels.
Conclusions:
- The majority of patients with type 2 diabetes do not achieve ADA-recommended lipid goals.
- Further research in larger cohorts is necessary to validate these findings and explore reasons for suboptimal lipid management.
Background:
Lipid abnormalities are twice as common in patients with type 2 diabetes, and this contributes substantially to their increased risk of cardiac disease. The American Diabetic Association (ADA) has defined treatment goals for high-density lipoprotein (HDL) cholesterol (>45 mg/dL), triglyceride (<200 mg/dL), and low-density lipoprotein (LDL) cholesterol (<100 mg/dL). It is unknown, however, how frequently patients with diabetes managed in primary care settings are able to attain these treatment goals.
Methods:
We randomly selected 239 patients with type 2 diabetes and conducted a chart review to determine whether patients had attained ADA lipid goals. We examined clinical predictors of goal attainment using logistic regression.
Results:
The number and percentage of patients who had attained ADA lipid goals was as follows: HDL cholesterol, 87 of 207 (42.0%); LDL cholesterol, 93 of 208 (47.0%); and triglyceride, 142 of 206 (70.0%). Only 30 of 206 (14.6%) patients had achieved all 3 lipid goals. Three groups of patients with diabetes had greater odds of achieving the LDL treatment goal: men, patients taking a lipid-lowering drug, and patients with hypertension. Patients with diabetes had greater odds of achieving the HDL goal if they were female, were black, or if they had lower values for body mass index and triglyceride. The odds of achieving the triglyceride goal were greater for men, for patients having Medicare insurance supplemented by private insurance, and for those with increasing values of HDL.
Conclusion:
We found that the majority of patients with diabetes failed to attain lipid goals set forth by the American Diabetes Association. Further study is needed in larger populations to confirm these findings, and if confirmed, to determine the reasons that patients fail to achieve lipid goals.
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