Comparison of hyperglycemia, hypertension, and hypercholesterolemia management in patients with type 2 diabetes.
OBJECTIVE
Cardiovascular disease is the leading cause of death in patients with type 2 diabetes. We compared hyperglycemia management with the management of the cardiovascular disease risk factors hypertension and hypercholesterolemia in a cohort of type 2 diabetes patients.


METHODS
We randomly selected 601 patients with type 2 diabetes seen at the outpatient practices of an academic medical center and assessed the care they received during an 18-month period. We compared proportions of patients who had hemoglobin A(1c) (HbA(1c)) levels, blood pressure, or total cholesterol levels measured; who had been prescribed any drug therapy if HbA(1c) levels, systolic blood pressure, or low-density lipoprotein (LDL) cholesterol levels exceeded recommended treatment goals; and who had been prescribed greater-than-starting-dose therapy if these values were above those of treatment goals.


RESULTS
Patients were less likely to have cholesterol levels (76%, n = 455) measured than HbA(1c) (92%, n = 552) levels or blood pressure (99%, n = 595; P <0.0001 for either comparison). The proportion of patients that received any drug therapy was greater for above-goal HbA(1c) (92%, n = 348) than for above-goal systolic blood pressure (78%, n = 274) or LDL cholesterol (38%, n = 82; P <0.0001 for each comparison). Similarly, patients whose HbA(1c) levels were above the treatment goal (80%, n = 302) were more likely to receive greater-than-starting-dose therapy, compared with those who had above-goal systolic blood pressure (62%, n = 218) and LDL cholesterol levels (13%, n = 28; P <0.0001).


CONCLUSIONS
In this cohort, hypercholesterolemia and hypertension were managed less aggressively than was hyperglycemia. Given the prevalence of cardiovascular disease in patients with type 2 diabetes, increased screening for hypercholesterolemia and more aggressive drug therapy for hypercholesterolemia and hypertension are needed.
Grant
Richard W
RW
General Medicine Division, Department of Medicine, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
Cagliero
Enrico
E
Murphy-Sheehy
Patricia
P
Singer
Daniel E
DE
Nathan
David M
DM
Meigs
James B
JB
D000368:Aged; D001794:Blood Pressure; D015331:Cohort Studies; D003327:Coronary Disease / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D005260:Female; D006442:Glycated Hemoglobin / Q000302:isolation & purification; D006801:Humans; D006937:Hypercholesterolemia / Q000150:complications / Q000628:therapy*; D006943:Hyperglycemia / Q000150:complications / Q000628:therapy*; D006973:Hypertension / Q000150:complications / Q000628:therapy*; D008297:Male; D015995:Prevalence; D012307:Risk Factors
D006442:Glycated Hemoglobin