The Challenge of Achieving National Cholesterol Goals in Patients With Diabetes

Kennedy, Amanda G.; MacLean, Charles D.; Littenberg, Benjamin; Ades, Philip A.; Pinckney, Richard G.

doi:10.2337/diacare.28.5.1029

Cited by 44 publications

(33 citation statements)

References 21 publications

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“…Our observations are consistent with other population-based (Kerr et al, 2004;Saydah et al, 2004) and clinicbased studies Kennedy et al, 2005;Wexler et al, 2005) of the general population with Type 2 diabetes. Second, we found that similar and substantial numbers of diabetes patients with and without SMI in this study met criteria for the metabolic syndrome, a cluster of risk factors including elevated cholesterol and blood pressure along with obesity and hyperglycemia that has been associated with increased mortality overall and from CVD in men and heightened risk of CVD in women .…”

Section: Discussionsupporting

confidence: 82%

Extent and Management of Cardiovascular Risk Factors in Patients With Type 2 Diabetes and Serious Mental Illness

Kreyenbuhl¹,

Dickerson²,

Medoff³

et al. 2006

Journal of Nervous &Amp; Mental Disease

103

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Cardiovascular disease is the leading cause of death in Type 2 diabetes, which commonly occurs in patients with serious mental illnesses (SMIs). We determined the extent to which patients with diabetes and SMI, relative to diabetes patients without SMI, met American Diabetes Association goals for cholesterol and blood pressure, met criteria for the metabolic syndrome, and were prescribed medications known to reduce cardiovascular events. We found that less than half of diabetes patients, both with and without SMI, met recommended goals for cholesterol levels; even fewer had adequate blood pressure control. In addition, a substantial proportion of all diabetes patients met metabolic syndrome criteria. However, diabetes patients with SMI were less likely to be prescribed cholesterol-lowering statin medications, angiotensin-converting enzyme inhibitors, and angiotensin receptor blocking agents than diabetes patients without SMI. Patients with both diabetes and SMI are treated less aggressively for high cardiovascular risk than diabetes patients without mental disorders. KeywordsType 2 diabetes; serious mental illness; cardiovascular risk; metabolic syndrome In 2002, Type 2 diabetes affected approximately 6.3% of the US population at an estimated cost of $132 billion (American Diabetes Association, 2003;Engelgau et al., 2004). Type 2 diabetes is associated with a twofold to fourfold increased risk for major cardiovascular events and is considered a coronary heart disease risk equivalent that confers a level of risk equal to that in patients with pre-existing cardiovascular disease (CVD; Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults, 2001). Cardiovascular and cerebrovascular complications of Type 2 diabetes account for 60% to 75% of deaths from this disease (Stamler et al., 1993). Metabolic abnormalities characteristic of Type 2 diabetes including insulin resistance and dyslipidemias contribute in part to the increased CVD risk, with emerging evidence suggesting that persistent hyperglycemia may also play a role (Nathan et al., 2003;Selvin et al., 2004 NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript frequent co-occurrence of hypertension, overweight and obesity, smoking, and reduced physical activity in patients with diabetes confers an additive CVD risk that exceeds the sum of their risks individually (Wilson et al., 1998). There is also mounting evidence that the cluster of risk factors that comprise the metabolic syndrome increases the risk for cardiovascular mortality , and by definition, would be expected to occur disproportionately in people with Type 2 diabetes.Persons with serious mental illnesses such as schizophrenia have an increased risk for Type 2 diabetes (Dixon et al., 2000) and other co-occurring medical conditions. Life expectancy in people with schizophrenia is 20% shorter than that of the general population (Newman and Bland, 1991), with the excess mortality largely attributed to higher rates of CVD (Brown et al., 2000;Os...

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Section: Discussionsupporting

confidence: 82%

Extent and Management of Cardiovascular Risk Factors in Patients With Type 2 Diabetes and Serious Mental Illness

Kreyenbuhl¹,

Dickerson²,

Medoff³

et al. 2006

Journal of Nervous &Amp; Mental Disease

103

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“…Although the majority of our patients were tested few met the goals, similar to patients in other studies [4,7,13,14]. It is important to note that approximately 75% had a BMI > 25 kg/m 2 , more than one third were obese.…”

Section: Discussionmentioning

confidence: 59%

Prevalence of Type 2 Diabetic Patients Within the Targets of Care Guidelines in Daily Clinical Practice: A Multi-Center Study in Brazil

Gomes¹,

Gianella²,

Faria³

et al. 2006

Rev Diabetic Stud

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■ AbstractMajor clinical studies have shown that the targets for blood glucose, lipid profile and blood pressure in type 2 diabetic patients are difficult to maintain in clinical practice. However, there are few data concerning South American populations. Using guidelines represented by the Brazilian Diabetes Society, we evaluated cardiovascular (CV) risk factors, glycemic control and the availability of screening for diabetes complications in 2233 (60% females) outpatients with type 2 diabetes aged 59.2 ± 11.3 yr and with a known duration of diabetes of 9.2 ± 7.2 yr, collected from 8 Brazilian cities. The outcome showed that less intensive clinical care available for diabetic patients in Brazil compared to western industrialized countries leads to widespread poor metabolic control and health status. Less than 30% of the patients reached the target for systolic (28.5%, < 130 mmHg) and diastolic (19.3%, < 80 mmHg) blood pressure, BMI (24.6%, < 25 kg/m 2 ), LDL cholesterol (20.6%, < 2.6 mmol/l) and only 46% reached the goal for HbA1c (one % point above the upper limits of normality for the method used). Only 0.2% of patients reached all the targets. A lower number of women reached the targets for HbA1c, LDL and HDL cholesterol than men (p < 0.001). Women were less likely than men to have funduscopy examinations and urine albumin testing (p < 0.001). We conclude that the national goals for glycemic control, blood pressure and lipid levels are rarely achieved in clinical practice, and that the availability for diabetic complication screening is low. The quality of diabetes care, in particular for women, is poor and should be further reviewed in developing countries.

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“…19 In our study, 43.7% of patients achieved LDL-C target levels of 100 mg/dL compared with 15.4% of patients in the NHANES III study 19 and 49.4% of diabetic patients from the Vermont Diabetes Information System Trial. 26 We found that it was even LDL-C = low-density lipoprotein cholesterol Note: Data are expressed as frequencies and percentages (in parentheses); the percentages in the "Row Totals" are row percentages and those in the "Column totals" are column percentages. Data from visit monitoring form.…”

Section: Discussionmentioning

confidence: 91%

Management of Type 2 Diabetes in the Primary Care Setting: A Practice-Based Research Network Study

Spann

Nutting

Galliher

et al. 2006

The Annals of Family Medicine

120

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PURPOSE We wanted to describe how primary care clinicians care for patients with type 2 diabetes.METHODS We undertook a cross-sectional study of 95 primary care clinicians and 822 of their established patients with type 2 diabetes from 4 practice-based, primary care research networks in the United States. Clinicians were surveyed about their training and practice. Patients completed a self-administered questionnaire about their care, and medical records were reviewed for complications, treatment, and diabetes-control indicators. RESULTSParticipating clinicians (average age, 45.7 years) saw an average of 32.6 adult patients with diabetes per month. Patients (average age, 59.7 years) reported a mean duration of diabetes of 9.1 years, with 34.3% having had the disease more than 10 years. Nearly one half (47.5%) of the patients had at least 1 diabetes-related complication, and 60.8% reported a body mass index greater than 30. Mean glycosylated hemoglobin (HbA 1c ) level was 7.6% (SD 1.73), and 40.5% of patients had values <7%. Only 35.3% of patients had adequate blood pressure control (<130/85 mm Hg), and only 43.7% had low-density lipoprotein cholesterol (LDL-C) levels <100 mg/dL. Only 7.0% of patients met all 3 control targets. Multilevel models showed that patient ethnicity, practice type, involvement of midlevel clinicians, and treatment were associated with HbA 1c level; patient age, education level, and practice type were associated with blood pressure control; and patient ethnicity was associated with LDL-C control.CONCLUSIONS Only modest numbers of patients achieve established targets of diabetes control. Reengineering primary care practice may be necessary to substantially improve care.

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The Challenge of Achieving National Cholesterol Goals in Patients With Diabetes

Cited by 44 publications

References 21 publications

Extent and Management of Cardiovascular Risk Factors in Patients With Type 2 Diabetes and Serious Mental Illness

Extent and Management of Cardiovascular Risk Factors in Patients With Type 2 Diabetes and Serious Mental Illness

Prevalence of Type 2 Diabetic Patients Within the Targets of Care Guidelines in Daily Clinical Practice: A Multi-Center Study in Brazil

Management of Type 2 Diabetes in the Primary Care Setting: A Practice-Based Research Network Study

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