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Item
#11
Cardiovascular
Risk Factors Are Poorly Controlled in People with Type 2 Diabetics
Study
shows a failure to achieve goals in reducing risk factors for CVD
unless diabetes education is part of treatment plan!
A
recent prospective observational study of 235 patients being
treated for type 2 diabetes showed a failure to achieve goals for
many modifiable risk factors of cardiovascular disease, Including
HbA1~ concentration, LDL-C and HDL-C values, blood
pressure (BP) level, and body mass Index (BMI). In fact, optimal
control of all modifiable risk Factors was found in only one
patient.
The
patients had been referred for elective cardiac catheterization
(81% had documented coronary artery disease at baseline) over
slightly more than a 2-year period.
Using
guidelines published by the American Diabetes Association and the
National institutes of Health, the investigators compared findings
in the study population with goals that included the following:
HbA1c <7%; LDL-C <100 mg/dL; HDL-C _45 mg/dL for men, _55
mg/dL for women; triglycerides <200 mg/dL; BP <130/85 mmHg;
and BMI <25.
Among
the results: Only 21% of patients met the HbA1c goal,
and only 52% met that for LDL-C. Even worse, optimal HDL-C levels
were achieved in only 22% of men and 18% of women.
Worst of all, the proportion of patients with the
recommended DP value was just 10%, that with the recommended BMI
11%. On the other hand, 76% of patients met the triglycerides
goal.
About
half of the patients were taking oral hypoglycemics and half
insulin. In addition, 47% were on lipid-lowering therapy, 40% were
taking an ACE inhibitor, 54% a fl-blocker, and 82% aspirin.
Acknowledging
that the sample size was small, but noting that It was derived
from a very broad patient base, the investigators concluded that
their findings may highlight major deficiencies in cardiovascular
risk Factor modification in the US population with diabetes as a
whole. Of particular concern was the poor glycemic control,
inadequate BP management! and suboptimal lipid treatment, given
current standards of diabetes care emphasizing the need for
aggressive treatment in each of those respects.
The
investigators speculated that such under-treatment may be brought
about in part by the numerous medications that patients with
diabetes are expected to take each day. An aggressive, yet
realistic treatment plan, combined with
diabetes education, would not only promote patient
compliance with an aggressive management scheme but would also
contribute to the scheme’s effectiveness.
Qeorga
PB at ci. Treetment of cardiac risk factors In diabetic
patients:How well do we follow the guidelines?
Am Heart J. 2001;142:B57-883
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Did
You Know:
For
every one-percentage point drop in the Hemoglobin A1c diabetes
complication rates drop by more than 25%
Source:
Diabetes 2001: Vital Stats.
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