title: Effectiveness of treat-to-target strategy for LDL-cholesterol control in type 2 diabetes: post-hoc analysis of data from the MIND.IT study.
abstract: BACKGROUND
  The paper presents a post-hoc analysis of the intensity of dyslipidaemia care operated in the first 2 years of Multiple-Intervention-in-type-2-Diabetes.ITaly (MIND.IT) study.
  
  
  METHODS
  MIND.IT is a multicentric, randomized, two-parallel arm trial involving 1461 type 2 diabetic patients at high cardiovascular (CV) risk. The study compares the usual care (UC) of CV prevention with a multifactorial intensive care (IC) approach aiming at achieving target values for the main CV risk factors according to a step-wise treat-to-target approach.
  
  
  RESULTS
  Proportion of patients on target for low-density lipoprotein cholesterol (LDL-C) was about 10% at baseline and increased significantly more with IC than UC (43 vs. 27%; p < 0.001). However, the majority (57%) of patients, in this intended intensively treated cohort, failed to achieve the proposed target. Average LDL-C decreased from 144 ± 35 to 108 ± 31 mg/dl with IC and from 142 ± 28 to 118 ± 32 with UC (p-for-interaction <0.0001). IC was associated with a significantly greater increase in statin prescription and lower withdrawal from treatment than UC (43 vs. 11% and 28 vs. 61%, respectively; both p < 0.001). However, the new treatments were characterized in both groups by the use of low starting doses (≤ 10 mg of atorvastatin, equivalent dose in more than 90% of patients) without increase in case of missed target.
  
  
  CONCLUSIONS
  The application of a multifactorial treat-to-target intervention is associated with a significant improvement in LDL-C beyond usual practice. However, the change in LDL-C appears to be more related to an increased number of treated patients and a decreased treatment withdrawal than to a true treat-to-target approach.
authors.affiliation: University of Parma, Parma, Italy.
authors.forename: Diego
authors.initials: D
authors.lastname: Ardigò
authors.forename: Olga
authors.initials: O
authors.lastname: Vaccaro
authors.forename: Franco
authors.initials: F
authors.lastname: Cavalot
authors.forename: Albarosa Angela
authors.initials: AA
authors.lastname: Rivellese
authors.forename: Laura
authors.initials: L
authors.lastname: Franzini
authors.forename: Roberto
authors.initials: R
authors.lastname: Miccoli
authors.forename: Lidia
authors.initials: L
authors.lastname: Patti
authors.forename: Massimo
authors.initials: M
authors.lastname: Boemi
authors.forename: Mariella
authors.initials: M
authors.lastname: Trovati
authors.forename: Ivana
authors.initials: I
authors.lastname: Zavaroni
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000209:etiology / Q000517:prevention & control*; D008078:Cholesterol, LDL / Q000097:blood*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D050171:Dyslipidemias / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D007558:Italy; D008297:Male; D008875:Middle Aged; D011322:Primary Prevention; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: Cardiovascular; cholesterol; diabetes; intervention; lipid; statins; treatment