title: LDL-cholesterol target values and actual values in patients with type 2 diabetes (T2D) uncontrolled on oral antidiabetic monotherapy: the lipid results of the French ESCALADE survey.
abstract: OBJECTIVE
  While new European guidelines have recommended much lower LDL-c target values than current 2005 French HAS guidelines, it appears that even those ones are not widely implemented. This lipid-side of the ESCALADE study was designed to determine the LDL-c target values of GPs, diabetologists (DIABs) and cardiologists (CARDIOs) and the consistency of actual values in patients with type 2 diabetes (T2D) uncontrolled on antidiabetic monotherapy.
  
  
  METHODS
  ESCALADE was a national multicentre, observational, descriptive, transversal survey. One thousand and three hundred GPs and 350 specialists (DIABs and CARDIOs) agreed to include respectively three and four patients each. For each patient, the physician had to set the LDL-c target value that was compared to the calculated HAS target value. The actual LDL-c value was recorded and compared to those target values.
  
  
  RESULTS
  A total of 412 GPs, 137 DIABs and 27 CARDIOs included respectively 699, 364 and 66 patients. Among them 19.6% had cardiovascular disease (CVD) and 56.9% were on lipid-lowering therapy (LLT). The physician's target value was in concordance with HAS value in 37.3% (GPs), 35.4% (DIABs) and 57.4% (CARDIOs) of the cases. Physicians overestimated the risk in respectively 42.7%, 54.1% and 21.3%. However, very high risk was underestimated in respectively 38.1%, 22.0% and 25.6% of the patients and the actual LDL-c value was in the target range (<100mg/dL) for only 28% of the very high-risk patients.
  
  
  CONCLUSIONS
  Physicians tend to overestimate the CVD risk in patients with T2D and set lower LDL-c target values than HAS calculated values. Nevertheless, patients with a very high risk are largely under-treated.
authors.affiliation: Department of Endocrinology-Metabolism and Diabetology-Nutrition, Jean Minjoz Hospital, EA 3920, University of Franche-Comté, 25030 Besançon cedex, France. alfred.penfornis@univ-fcomte.fr
authors.forename: Alfred
authors.initials: A
authors.lastname: Penfornis
authors.forename: Alain
authors.initials: A
authors.lastname: Baleydier
authors.forename: Thierry
authors.initials: T
authors.lastname: Clavel
authors.forename: Sylvie
authors.initials: S
authors.lastname: Picard
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D008078:Cholesterol, LDL / Q000032:analysis / Q000097:blood*; D003625:Data Collection; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000188:drug therapy* / Q000453:epidemiology; D003940:Diagnostic Techniques, Endocrine / Q000592:standards; D005260:Female; D005602:France / Q000453:epidemiology; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D012016:Reference Values
chemical_list: D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D008055:Lipids; C517652:hemoglobin A1c protein, human