title: Lack of goal attainment regarding the low-density lipoprotein cholesterol level in the management of type 2 diabetes mellitus.
abstract: OBJECTIVE
  The management of diabetes mellitus includes controlling the blood glucose level, body weight, blood pressure and serum lipid level. The coexistence of diabetes and a high low-density lipoprotein cholesterol (LDL-C) level promotes atherosclerosis of the coronary arteries and increases the risk of coronary artery disease (CAD). We compared the rates of attainment of LDL-C goals in type 2 diabetes patients receiving primary and secondary prevention therapy, the former without a history of CAD and the latter with a history of CAD. Because patients receiving secondary prevention are at greater risk of coronary events, LDL-C management is especially important in this group. This study was designed to determine how frequently diabetic patients attain their LDL-C goals and identify the reasons for the lack of attainment.
  
  
  METHODS
  The groups were distinguished according to the patients' medical records. Contributory factors for the patients not achieving their goals were recorded in a questionnaire filled out by each patient's physician.
  
  
  RESULTS
  The overall attainment rate in both groups was 61%. The most frequent impediment in both groups was "an LDL-C level above or below the goal at every hospital visit" followed by "continuously sufficient effects of dietary therapy only" and the "management of LDL-C by other departments or hospitals," the latter reflecting the increasing problems of polydisease and polypharmacy in diabetes care.
  
  
  CONCLUSIONS
  Polydisease and polypharmacy issues in diabetes patients with a history of CAD constitute a growing barrier to medication adherence and the attainment of treatment goals.
authors.affiliation: Department of Diabetes, Endocrinology and Nutrition, Graduate School of Medicine, Kyoto University, Japan.
authors.forename: Masaya
authors.initials: M
authors.lastname: Hosokawa
authors.forename: Akihiro
authors.initials: A
authors.lastname: Hamasaki
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Nagashima
authors.forename: Shinichi
authors.initials: S
authors.lastname: Harashima
authors.forename: Kentaro
authors.initials: K
authors.lastname: Toyoda
authors.forename: Yoshihito
authors.initials: Y
authors.lastname: Fujita
authors.forename: Norio
authors.initials: N
authors.lastname: Harada
authors.forename: Yuko
authors.initials: Y
authors.lastname: Nakahigashi
authors.forename: Shimpei
authors.initials: S
authors.lastname: Fujimoto
authors.forename: Nobuya
authors.initials: N
authors.lastname: Inagaki
mesh_terms: D000368:Aged; D008078:Cholesterol, LDL / Q000097:blood*; D003324:Coronary Artery Disease / Q000097:blood / Q000209:etiology / Q000517:prevention & control; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000150:complications / Q000188:drug therapy*; D058065:Diabetic Cardiomyopathies / Q000097:blood / Q000209:etiology / Q000517:prevention & control; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007564:Japan; D008297:Male; D011322:Primary Prevention; D012307:Risk Factors; D055502:Secondary Prevention; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D007004:Hypoglycemic Agents