Lipid Control in Patients With Type 2 Diabetes Mellitus: A Continuous Quality Improvement Study.

Area of Science:

• Endocrinology
• Cardiology
• Public Health

Background:

• Type 2 diabetes mellitus (T2DM) is highly prevalent in Portugal, posing significant cardiovascular risk (CVR).
• Effective dyslipidemia management is crucial for improving long-term health outcomes in T2DM patients.
• Current lipid control rates and therapeutic inertia present challenges in CVR management.

Purpose of the Study:

• To enhance lipid management in T2DM patients within a Portuguese family health unit.
• To achieve a 25% lipid control rate through a continuous quality improvement initiative.
• To reduce therapeutic inertia in lipid-lowering therapy adjustments.

Main Methods:

• A continuous quality improvement study involving independent random samples of T2DM patients across three assessment periods (2022-2024).
• Interventions included team-based training, electronic reminders, visual aids, performance feedback, and collaborative consultations.
• Lipid control was assessed using LDL-C and non-HDL-C targets based on CVR, with therapeutic inertia defined as lack of treatment adjustment.

Main Results:

• Lipid control improved from 20.4% at baseline to 32.5% in the final assessment, a 12.1 percentage point increase (p<0.001).
• Therapeutic inertia decreased significantly from 93.9% to 73.8% (p<0.001), with notable improvements in high and very high CVR groups.
• Median LDL-C levels significantly reduced (p<0.001), though a proportion of patients remained undertreated, and combination therapy use was infrequent.

Conclusions:

• The implemented intervention successfully improved lipid control and reduced therapeutic inertia in T2DM patients.
• Despite improvements, lipid control remains suboptimal, highlighting the need for ongoing professional and patient education.
• Future strategies should focus on combination therapy, patient-specific adherence approaches, and clinical decision support tools to further reduce therapeutic inertia and cardiovascular events.