title: For the majority of patients with diabetes blood pressure and lipid management is not in line with recommendations. Results from a large population-based cohort in Germany.
abstract: OBJECTIVE
  To evaluate the management of cardiovascular risk factors in a population-based cohort of adults with diabetes mellitus in Germany.
  
  
  METHODS
  For the 9953 participants (50-74 years of age) of the ESTHER study, diabetes mellitus, hypertension, dyslipidemia and the respective medication were documented at baseline by their primary care physician. Blood pressure was taken and lipid levels were determined from a blood sample drawn at recruitment. Lifestyle factors (smoking, BMI, physical activity) were documented by the participants. Prevalence of pharmacotherapy for and control of hypertension and dyslipidemia among diabetic patients with these diagnoses were assessed and determinants were evaluated by multiple logistic regression.
  
  
  RESULTS
  Diabetes mellitus was present in 1375 participants (14.2%). Almost 78% of diabetic participants had physician diagnosed hypertension, 86.0% received pharmacotherapy, but only 12.8% of those with anti-hypertensive medication achieved blood pressure levels below 130/85 mmHg. Obese participants were more likely to receive anti-hypertensive pharmacotherapy than non-obese ones: adjusted odds ratio (OR, 95% confidence interval (CI)): 3.58 (1.86-6.87). Gender had no influence on anti-hypertensive pharmacotherapy. Older diabetic patients with hypertension were less likely to have sufficient blood pressure control than younger ones. Dyslipidemia was documented in 50% of diabetic patients. Diabetic participants with coronary heart disease or hypertension were more likely to receive lipid-lowering pharmacotherapy than those without these conditions (adjusted OR 1.85 (95%CI 1.19-2.89) and 2.59 (95%CI 1.41-4.74), respectively).
  
  
  CONCLUSIONS
  For most elderly with diabetes cardiovascular risk factor management continues to be not in line with recommendations.
authors.affiliation: Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany. e.raum@dkfz-heidelberg.de
authors.forename: Elke
authors.initials: E
authors.lastname: Raum
authors.forename: Susanne
authors.initials: S
authors.lastname: Lietzau
authors.forename: Christa
authors.initials: C
authors.lastname: Stegmaier
authors.forename: H
authors.initials: H
authors.lastname: Brenner
authors.forename: Dietrich
authors.initials: D
authors.lastname: Rothenbacher
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D002318:Cardiovascular Diseases / Q000209:etiology / Q000517:prevention & control*; D015331:Cohort Studies; D048909:Diabetes Complications / Q000517:prevention & control*; D003920:Diabetes Mellitus / Q000503:physiopathology*; D005260:Female; D005858:Germany / Q000453:epidemiology; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D006949:Hyperlipidemias / Q000150:complications / Q000188:drug therapy; D006973:Hypertension / Q000150:complications / Q000188:drug therapy; D008019:Life Style; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000188:drug therapy; D017410:Practice Guidelines as Topic; D015995:Prevalence; D012307:Risk Factors; D012737:Sex Factors
chemical_list: D000959:Antihypertensive Agents