Guidelines improve general trend of lowered cholesterol levels in type 2 diabetes patients in spite of low adherence.
BACKGROUND
New guidelines were introduced in Sweden in 1999 to reduce the risk of cardiovascular disease among diabetes patients. The impact of the new guidelines on lipid levels in a diabetes patient population has not been extensively studied. Our aim was to study whether the introduction of treatment goals for dyslipidaemia was reflected in lower cholesterol levels in patients with diabetes in a general population.


METHODS
In a population of 59,338 individuals, 971 (1.6%) had diabetes. All subjects were 40, 50 or 60 years of age and participated in the Vasterbotten Intervention Programme in 1995-2004. Cholesterol levels and use of lipid-lowering drugs were measured, and trends in cholesterol levels were analysed before and after the guidelines were introduced in 1999.


RESULTS
In this effectiveness study, there was a marked decrease in mean plasma total cholesterol levels among patients with diabetes (5.79 (+/- 1.21) mmol/1 in 1995-1999 and 5.07 (+/- 1.00) mmol/1 in 2000-2004 (p<0.001)) as well as in the non-diabetic population (5.79 (+/-1.15) mmol/1 and 5.41 (+/-1.07) mmol/1 (p<0.001)). The trend in diabetes patients was influenced by increased use of lipid-lowering agents, even though only 25.3% (male/female 26.8%/23.2%) of the diabetes patients received lipid-lowering treatment after the introduction of the new guidelines.


CONCLUSIONS
Since the introduction of the guidelines, an increasing number of diabetes patients are receiving lipid-lowering drugs, which enhance a strong general trend of lowered cholesterol levels. Yet, the vast majority of diabetes patients with hypercholesterolaemia still do not receive medical treatment in accordance with the guidelines.
Fhärm
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Family Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden, eva.fharm@vll.se
Rolandsson
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Weinehall
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D000328:Adult; D002318:Cardiovascular Diseases / Q000097:blood / Q000209:etiology / Q000517:prevention & control; D002784:Cholesterol / Q000097:blood*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000150:complications / Q000188:drug therapy; D005260:Female; D019983:Guideline Adherence; D006304:Health Status; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D008019:Life Style; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D012307:Risk Factors; D011795:Surveys and Questionnaires
D000960:Hypolipidemic Agents; D002784:Cholesterol