Cardiovascular risk factors control in Polish patients with type 2 diabetes within the first two years of diagnosis: results of the ARETAEUS1 study.
BACKGROUND
The practice guidelines of cardiological and diabetological societies emphasise that cardiovascular (CV) risk control in diabetic patients is especially important and should be stricter than in subjects without diabetes. There are little data on the frequency of meeting treatment goals in patients with newly diagnosed diabetes mellitus type 2 (DM2).


OBJECTIVE
To characterise Polish patients with DM2 diagnosed within the previous two years and to assess if the treatment targets from the current (2008) guidelines of Diabetes Poland regarding control of CV risk factors are met.


METHODS
ARETAEUS1 was a cross-sectional questionnaire-based study conducted in various regions of Poland in 2009 (January-April). It involved 1,714 patients of all ages and both genders, who had DM2 treated for less than 24 months. They were recruited by randomly selected physicians.


RESULTS
Total cholesterol treatment goal (< 4.5 mmol/L) was met in 22% of all patients, triglycerides treatment goal (< 1.7 mmol/L) in 44%, LDL cholesterol treatment goal (< 2.6 mmol/L) in 20% and HDL cholesterol treatment goal (> 1.0 mmol/L in men and > 1.3 mmol/L in women) in 55%. Only 13% of the overall population met the goal of blood pressure (BP) below 130/80 mm Hg. When a less restrictive BP control threshold (< 140/90 mm Hg) was applied, 48% of patients had their BP below the threshold. In the analysis of subgroups (patients with and without previous CV events; receiving 1-5 or not receiving antihypertensive drugs; receiving and not receiving statins and fibrates) we observed from 0% to 3.3% of patients meeting three (HbA1c, BP and cholesterol) treatment goals. The percentages of patients meeting two out of three treatment goals were between 8% and 33% in different subgroups. The percentages of patients meeting only one out of three treatment goals ranged from 27.8% to 46.7% or at least one - from 39% to 69%.


CONCLUSIONS
Most patients with newly diagnosed diabetes are not meeting their treatment goals regarding control of CV risk factors, which indicates relatively low adherence to national guideline recommendations for diabetes control and primary CV prevention in DM2. Difficulties in achieving CV treatment targets in the diabetic population indicate the need for a great deal of effort on the part of clinicians and patients. Practice guidelines developers should consider what treatment targets are achievable at a reasonable expense of effort.
Polish Institute of Evidence Based Medicine, Krakow, Poland. gosiabala@mp.pl
Małgorzata M
MM
Bała
Wiktoria
W
Leśniak
Ewa
E
Płaczkiewicz-Jankowska
Roman
R
Topór-Mądry
Roman
R
Jaeschke
Jacek
J
Sieradzki
Władysław
W
Grzeszczak
Waldemar
W
Banasiak
D000959:Antihypertensive Agents / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000517:prevention & control*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology; D010349:Patient Compliance / Q000706:statistics & numerical data; D011044:Poland / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D011795:Surveys and Questionnaires
D000959:Antihypertensive Agents