Comparison of Hyperglycemia, Hypertension, and Hypercholesterolemia Management in Patients With Type 2 Diabetes

Am J Med. 2002 Jun 1;112(8):603-9. doi: 10.1016/s0002-9343(02)01103-8.

Abstract

Purpose: Cardiovascular disease is the leading cause of death in patients with type 2 diabetes. We compared hyperglycemia management with the management of the cardiovascular disease risk factors hypertension and hypercholesterolemia in a cohort of type 2 diabetes patients.

Subjects and methods: We randomly selected 601 patients with type 2 diabetes seen at the outpatient practices of an academic medical center and assessed the care they received during an 18-month period. We 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-dose therapy if these values were above those of treatment goals.

Results: 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, compared with those who had above-goal systolic blood pressure (62%, n = 218) and LDL cholesterol levels (13%, n = 28; P <0.0001).

Conclusion: In this cohort, hypercholesterolemia and hypertension were managed less aggressively than was hyperglycemia. Given the prevalence of cardiovascular disease in patients with type 2 diabetes, increased screening for hypercholesterolemia and more aggressive drug therapy for hypercholesterolemia and hypertension are needed.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Aged
  • Blood Pressure
  • Cohort Studies
  • Coronary Disease / epidemiology
  • Diabetes Mellitus, Type 2 / complications*
  • Female
  • Glycated Hemoglobin A / isolation & purification
  • Humans
  • Hypercholesterolemia / complications
  • Hypercholesterolemia / therapy*
  • Hyperglycemia / complications
  • Hyperglycemia / therapy*
  • Hypertension / complications
  • Hypertension / therapy*
  • Male
  • Prevalence
  • Risk Factors

Substances

  • Glycated Hemoglobin A