Compliance with recommendations for lipid management among patients with type 2 diabetes in an academic family practice.
BACKGROUND
Lipid abnormalities are twice as common in patients with type 2 diabetes, and this contributes substantially to their increased risk of cardiac disease. The American Diabetic Association (ADA) has defined treatment goals for high-density lipoprotein (HDL) cholesterol (>45 mg/dL), triglyceride (<200 mg/dL), and low-density lipoprotein (LDL) cholesterol (<100 mg/dL). It is unknown, however, how frequently patients with diabetes managed in primary care settings are able to attain these treatment goals.


METHODS
We randomly selected 239 patients with type 2 diabetes and conducted a chart review to determine whether patients had attained ADA lipid goals. We examined clinical predictors of goal attainment using logistic regression.


RESULTS
The number and percentage of patients who had attained ADA lipid goals was as follows: HDL cholesterol, 87 of 207 (42.0%); LDL cholesterol, 93 of 208 (47.0%); and triglyceride, 142 of 206 (70.0%). Only 30 of 206 (14.6%) patients had achieved all 3 lipid goals. Three groups of patients with diabetes had greater odds of achieving the LDL treatment goal: men, patients taking a lipid-lowering drug, and patients with hypertension. Patients with diabetes had greater odds of achieving the HDL goal if they were female, were black, or if they had lower values for body mass index and triglyceride. The odds of achieving the triglyceride goal were greater for men, for patients having Medicare insurance supplemented by private insurance, and for those with increasing values of HDL.


CONCLUSIONS
We found that the majority of patients with diabetes failed to attain lipid goals set forth by the American Diabetes Association. Further study is needed in larger populations to confirm these findings, and if confirmed, to determine the reasons that patients fail to achieve lipid goals.
Putzer
Gavin
G
Department of Family Medicine, University of South Florida, Tampa, FL 33612, USA.
Roetzheim
Richard
R
Ramirez
Arnold M
AM
Sneed
Kevin
K
Brownlee
H J
HJ
Campbell
Robert J
RJ
D000046:Academic Medical Centers; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D005194:Family Practice / Q000592:standards*; D005260:Female; D005431:Florida; D006801:Humans; D006949:Hyperlipidemias / Q000150:complications / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010349:Patient Compliance / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000592:standards; D012307:Risk Factors; D012494:Sampling Studies