title: Impact of physicians' beliefs and practices on cholesterol levels in patients with type 2 diabetes: a longitudinal assessment.
abstract: BACKGROUND
  Clinical trials demonstrate significant benefit from cholesterol management for patients with type 2 diabetes. The aim of this work was to explore the correlates of lipid management in patients with type 2 diabetes, including the subjective beliefs of physicians, setting of care, and patient-related factors.
  
  
  METHODS
  This longitudinal outcomes research study involved 2359 patients with type 2 diabetes recruited by 111 general practitioners and 214 physicians practicing in diabetes clinics. Physicians' beliefs were assessed through a questionnaire administered when the study started in 1998. Main outcome measures were total cholesterol (TC) and LDL cholesterol (LDL-C) levels over 3 years and the proportion of patients treated with lipid-lowering drugs (LLDs).
  
  
  RESULTS
  Less than one-third of the physicians (27%) stated that they routinely started pharmacologic therapy for TC values > or =200 mg/dL (more aggressive), whereas 46% considered a TC level > or =240 mg/dL as the threshold for the initiation of treatment (less aggressive). During 3 years of observation, mean TC and LDL-C levels decreased from 215 +/- 40 mg/dL to 203 +/- 37 mg/dL and from 135 +/- 36 mg/dL to 126 +/- 35 mg/dL respectively, while the proportion of patients treated with LLDs increased from 13.2% to 24.6%; in particular, among individuals cared for by the more aggressive physicians, 30.0% were taking LLDs after 3 years, while only 17.7% of those followed by the less aggressive physicians and 18.1% of those followed by >1 physician were being treated with LLDs. Multilevel analysis showed that physicians' beliefs were an independent predictor of TC levels over the 3-year period. In patients treated with LLDs, TC levels decreased on average by 14%, and LDL-C levels decreased by 20%.
  
  
  CONCLUSIONS
  Our data show that physicians' beliefs in more aggressive management strategies will result in better mean TC values over a 3-year period.
authors.affiliation: Department of Clinical Pharmacology and Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri, Consorzio Mario Negri Sud, Santa Maria Imbaro, Italy.
authors.forename: Monica
authors.initials: M
authors.lastname: Franciosi
authors.forename: Fabio
authors.initials: F
authors.lastname: Pellegrini
authors.forename: Giorgia
authors.initials: G
authors.lastname: De Berardis
authors.forename: Maurizio
authors.initials: M
authors.lastname: Belfiglio
authors.forename: Barbara
authors.initials: B
authors.lastname: Di Nardo
authors.forename: Sheldon
authors.initials: S
authors.lastname: Greenfield
authors.forename: Sherrie H
authors.initials: SH
authors.lastname: Kaplan
authors.forename: Maria C E
authors.initials: MC
authors.lastname: Rossi
authors.forename: Michele
authors.initials: M
authors.lastname: Sacco
authors.forename: Gianni
authors.initials: G
authors.lastname: Tognoni
authors.forename: Miriam
authors.initials: M
authors.lastname: Valentini
authors.forename: Antonio
authors.initials: A
authors.lastname: Nicolucci
mesh_terms: D001291:Attitude of Health Personnel; D002784:Cholesterol / Q000097:blood*; D008078:Cholesterol, LDL / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000150:complications; D005260:Female; D006801:Humans; D006949:Hyperlipidemias / Q000150:complications / Q000188:drug therapy*; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D007558:Italy; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D011795:Surveys and Questionnaires; D014280:Triglycerides / Q000097:blood
chemical_list: D008078:Cholesterol, LDL; D000960:Hypolipidemic Agents; D014280:Triglycerides; D002784:Cholesterol