ADA: Better Lipid Management Needed in Patients with Diabetes and Heart Disease

Study shows that CAD patients with diabetes are under-tested and under-treated.

As a result of these findings, the researchers called for interventions to help physicians improve their use of lipid testing and drug therapy for patients with diabetes and coronary artery disease (CAD).

The findings were presented here Friday at the 62nd Scientific Sessions of the American Diabetes Association (ADA).

Dr. Mark Massing, with Medical Review of North Carolina in Cary, North Carolina, United States and co-workers studied trends in lipid management from 1996 to early 1998 among CAD patients with and without diabetes mellitus (DM) seen at 295 outpatient practices in the US by 1,540 physicians participating in the Quality Assurance Program. About 23 percent of the 47,813 CAD patients included in their analyses had diabetes.

During the study period, lipid profile testing rates among patients with DM increased dramatically from 28 percent to 50 percent. Even so, rates of lipid profile testing were 20 percent lower among patients with DM compared to those without DM (odds ratio 0.8 , 95 percent confidence interval: 0.7, 0.8).

Prescriptions for cholesterol-lowering drugs among patients with DM increased form 33 percent to 50 percent.

While trends in cholesterol lowering drug prescriptions were similar for those with and without DM, those with DM were 20 percent less likely to receive a prescription than those without the condition.

As lipid treatment improved, the mean low-density lipoprotein (LDL)-cholesterol values declined for patients with and without diabetes. Among patients treated with cholesterol-lowering drugs, the percent decline over time for mean LDL-cholesterol was greater for those who did not have DM (15 percent) compared to those with DM (7 percent)

Overall, the data indicate that lipid management improved markedly for CAD patients with and without diabetes during this time period, Dr. Massing observed. However, despite their high-risk status that requires more aggressive treatment, there was no evidence of such treatment in patients CAD patients with DM compared to those who did not have DM.

Dr. Massing said that the study is limited by the fact that individual patients were not followed over time, which means that trends comparing different populations over time may be misleading. Also, patient information from physicians in non-participating practices was not available. On the other hand, he said, an important strength of the study is that it included a very large cohort of patients seen at some of the largest medical practices in the US.