Cholesterol management of patients with diabetes in a primary care practice-based research network.
OBJECTIVE
To determine the proportion of diabetic patients with and without coronary heart disease (CHD) who attained the American Diabetes Association recommended low-density lipoprotein cholesterol (LDL-C) target level of < or = 2.60 mmol/L (< or = 100 mg/dL).


METHODS
Retrospective cross-sectional study.


METHODS
Patients were identified by searching an electronic medical record database from March 1997 through March 2001. Search strategies included a problem list entry of diabetes mellitus or CHD, a medication in the antidiabetic or nitrate class, or a glycosylated hemoglobin value of > or = 7.0%. Additional information included patient demographics, last LDL-C level, and use of a lipid-lowering agent.


RESULTS
The study identified 10,201 patients (4844 with diabetes only, 1243 with diabetes plus CHD, and 4114 with CHD only). A greater proportion of patients who had diabetes and CHD attained the LDL-C target goal compared with patients who had diabetes only (32.1% vs 18.1%; P < .001). Furthermore, patients with diabetes plus CHD were more likely to have a LDL-C level measured within the past year (50.2% vs 42.5% respectively; P < .001). Multivariate logistic regression analysis revealed several factors associated with LDL-C goal attainment, including prior history of CHD, lipid-lowering therapy, tight glycemic control, HMO insurance, and a family medicine provider.


CONCLUSIONS
Although LDL-C goal attainment in patients with diabetes plus CHD was significantly better than that in patients with diabetes only, the prevalence of inadequate control in these high-risk populations is of national concern.
Department of Primary Care Research, Providence Medical Group, Beaverton, Ore 97005, USA. dawn.fuke@providence.org
Dawn
D
Fuke
Jacquelyn
J
Hunt
Joseph
J
Siemienczuk
Michael
M
Estoup
Michael
M
Carroll
Nicola
N
Payne
Daniel
D
Touchette
D000328:Adult; D000368:Aged; D000924:Anticholesteremic Agents / Q000627:therapeutic use; D008078:Cholesterol, LDL / Q000097:blood*; D003327:Coronary Disease / Q000517:prevention & control; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000097:blood*; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D009922:Oregon; D011320:Primary Health Care / Q000458:organization & administration*; D012189:Retrospective Studies
D000924:Anticholesteremic Agents; D008078:Cholesterol, LDL