Blood pressure and lipid management fall far short in persons with type 2 diabetes: results from the DIAB-CORE Consortium including six German population-based studies

Abstract

BackgroundAlthough most deaths among patients with type 2 diabetes (T2D) are attributable to cardiovascular disease, modifiable cardiovascular risk factors appear to be inadequately treated in medical practice. The aim of this study was to describe hypertension, dyslipidemia and medical treatment of these conditions in a large population-based sample.MethodsThe present analysis was based on the DIAB-CORE project, in which data from five regional population-based studies and one nationwide German study were pooled. All studies were conducted between 1997 and 2006. We assessed the frequencies of risk factors and co-morbidities, especially hypertension and dyslipidemia, in participants with and without T2D. The odds of no or insufficient treatment and the odds of pharmacotherapy were computed using multivariable logistic regression models. Types of medication regimens were described.ResultsThe pooled data set comprised individual data of 15, 071 participants aged 45–74 years, including 1287 (8.5%) participants with T2D. Subjects with T2D were significantly more likely to have untreated or insufficiently treated hypertension, i.e. blood pressure of > = 140/90 mmHg (OR = 1.43, 95% CI 1.26-1.61) and dyslipidemia i.e. a total cholesterol/HDL-cholesterol ratio > = 5 (OR = 1.80, 95% CI 1.59-2.04) than participants without T2D. Untreated or insufficiently treated blood pressure was observed in 48.9% of participants without T2D and in 63.6% of participants with T2D. In this latter group, 28.0% did not receive anti-hypertensive medication and 72.0% were insufficiently treated. In non-T2D participants, 28.8% had untreated or insufficiently treated dyslipidemia. Of all participants with T2D 42.5% had currently elevated lipids, 80.3% of these were untreated and 19.7% were insufficiently treated.ConclusionsBlood pressure and lipid management fall short especially in persons with T2D across Germany. The importance of sufficient risk factor control besides blood glucose monitoring in diabetes care needs to be emphasized in order to prevent cardiovascular sequelae and premature death.

Cardiovascular risk management in type 2 diabetes of more than 10-year duration: Results of Polish ARETAEUS2-Grupa Study

“…This inconsistency of guidelines may contribute to possible overuse of ASA for primary prevention in T2DM in our study. Finally, it is necessary to mention that management of CV risk factors in diabetic patients is challenging and is regarded as unsatisfactory not only in Poland but also in other countries from EU and outside Europe [19][20][21][22][23][24]. Of note, it was observed by Polish researchers [25] that control of CV risk factors was better in CAD patients than in diabetic patients, although still unsatisfactory in most of them; it shows that DM is still not perceived as dangerous and life-threatening as CAD.…”

Leczenie i spełnianie celów leczenia u polskich chorych na cukrzycę typu 2 od ponad 10 lat — wyniki badania ARETAEUS2-Grupa

“…Studies conducted in other countries also showed that most diabetic patients do not meet their HbA1c, BP and lipid treatment goals [20][21][22][23][24][25][26]. The most recent survey in U.S. patients [26] showed improvements in diabetes control over 12 years, but only 14% of patients met all their treatment goals (HbA1c ≤ 7% and individualised goals, BP < 130/80 mm Hg and LDL-cholesterol < 100 mg/dL and < 70 mg/dL in those with CHD) and achieved non-smoking status, which is slightly better than in our study (8%).…”

Diabeto Priežiūros Klinikinis Auditas Vilniaus Universiteto Ligoninės Santariškių Klinikų Šeimos Medicinos Centre

“…Kituose tyrimuose hipertenzijos dažnis diabetu sergantiems pacientams panašus -svyruoja 50-83 proc. ribose [8,9,11,17,21]. Hipertenzija dažniausiai gydyta renino-angiotenzino sistemą slopinančiais vaistais: AKFI skirti 63,9 proc., ARB -24,3 proc.…”

“…pacientų. Šie preparatai rekomenduojami kaip pirmo pasirinkimo vaistai gydant hipertenziją diabetu sergantiems ligoniams, taip pat dažniausiai skiriami ir kitose šalyse [8,17]. Atkreiptinas dėmesys, kad daliai pacientų AKFI skirti su ARB, nors arterinės hipertenzijos gydymo gairėse toks derinys nerekomenduojamas.…”

“…Nustatytas kardiovaskulinių komplikacijų ir intervencijų dažnis nesiskyrė nuo kitose šalyse atliktų tyrimų rezultatų [8,13,17].…”