Issue 118 Item 15 Hyperglycemia Management Vs. Hypertension and Lipid Management

Increased screening for hypercholesterolemia and more aggressive drug therapy for hypercholesterolemia and hypertension are needed. With cardiovascular disease being the leading cause of death in patients with type 2 diabetes, the study compared hyperglycemia management with the management of the cardiovascular disease risk factors hypertension and hypercholesterolemia in a cohort of type 2 diabetes patients.

601 patients with type 2 diabetes were randomly selected and seen at the outpatient practices of all academic medical center and assessed the care they received during an 18-month period. They compared proportions of patients who had hemoglobin A(1c) (HbA(1c)) levels, blood pressure, or total cholesterol levels measured; who had been prescribed any drug therapy if HbA(1c) levels, systolic blood pressure, or low-density lipoprotein (LDL) cholesterol levels exceeded recommended treatment goals; and who had been prescribed greater-than-starting- close therapy if these values were above those of treatment goals.

The results showed that patients were less likely to have cholesterol levels (76%, n = 455) measured than HbA(1c) (92%, n = 552) levels or blood pressure (99%, n = 595; P <0.0001 for either comparison). The proportion of patients that received any drug therapy was greater for above-goal HbA(1c) (92%, n = 348) than for above-goal systolic blood pressure (78%, n = 274) or LDL cholesterol (38%, n = 82; P <0.0001 for each comparison). Similarly, patients whose HbA(1c) levels were above the treatment goal (80%, n = 302) were more likely to receive greater-than-starting-dose therapy, compa-red with those who had above-goal systolic blood pressure (62%, n = 218) and LDL cholesterol levels (13%, n = 28, P <0.0001).

From the results it was concluded that in this cohort, hypercholesterolemia and hypertension were managed less aggressively than was hyperglycemia. Given the prevalence of car-diovascular disease in patients with Type 2 diabetes, increased screening for hypercholesterolemia and more aggressive drug therapy for hypercholesterolemia and hypertension are needed. American Journal of Medicine 2002 112/8 (603-609