Guidelines improve general trend of lowered cholesterol levels in type 2 diabetes patients in spite of low adherence

Abstract

Background: New guidelines were introduced in Sweden in 1999 to reduce the risk of cardiovascular disease among diabetes patients. The impact of the new guidelines on lipid levels in a diabetes patient population has not been extensively studied. Our aim was to study whether the introduction of treatment goals for dyslipidaemia was reflected in lower cholesterol levels in patients with diabetes in a general population. Methods: In a population of 59,338 individuals, 971 (1.6%) had diabetes. All subjects were 40, 50 or 60 years of age and participated in the Vasterbotten Intervention Programme in 1995-2004. Cholesterol levels and use of lipid-lowering drugs were measured, and trends in cholesterol levels were analysed before and after the guidelines were introduced in 1999. Results: In this effectiveness study, there was a marked decrease in mean plasma total cholesterol levels among patients with diabetes (5.79 (± 1.21) mmol/1 in 1995-1999 and 5.07 (± 1.00) mmol/1 in 2000-2004 (p<0.001)) as well as in the non-diabetic population (5.79 (±1.15) mmol/1 and 5.41 (±1.07) mmol/1 (p<0.001)). The trend in diabetes patients was influenced by increased use of lipid-lowering agents, even though only 25.3% (male/female 26.8%/23.2%) of the diabetes patients received lipid-lowering treatment after the introduction of the new guidelines. Conclusions: Since the introduction of the guidelines, an increasing number of diabetes patients are receiving lipid-lowering drugs, which enhance a strong general trend of lowered cholesterol levels. Yet, the vast majority of diabetes patients with hypercholesterolaemia still do not receive medical treatment in accordance with the guidelines.

Keywords

Antilipaemic agents diabetes mellitus effectiveness epidemiology guideline adherence hypercholesterolaemia

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References

Florkowski CM , Scott RS , Moir CL , Graham PJ Lipid but not glycaemic parameters predict total mortality from type 2 diabetes mellitus in Canterbury . NZ Diabetic Med 1998;15:386-92.

Kaukua J. , Turpeinen A. , Uusitupa M. , Niskanen L. Clustering of cardiovascular risk factors in type 2 diabetes mellitus: prognostic significance and tracking . Diabetes Obesity Metab 2001;3:17-23.

Turner RC , Millns H. , Neil HA , Stratton IM , Manley SE , Matthews DR , Holman RR Risk factors for coronary artery disease in non-insulin dependent diabetes mellitus: United Kingdom Prospective Diabetes Study (UKPDS: 23) . BMJ 1998;316:823-8.

American Diabetes Association. Standards of medical care for patients with diabetes mellitus . Diabetes Care 1994 ;17:616-23.

American Diabetes Association. Detection and management of lipid disorders in diabetes . Diabetes Care 1993;16: 828-34.

Marks JB , Raskin P. Cardiovascular risk in diabetes . J Diabetes Complications 2002;14:108-15.

Gaede P. , Vedel P. , Larsen N. , Jensen G. , Parving H. , Pedersen O. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes . N Engl J Med 2003;348:383-93.

National Guidelines for the Care and Treatment of Diabetes Mellitus. Stockholm: National Board of Health and Welfare; 1999 (in Swedish).

Lawler FH , Viviani N. Patient and physician perspectives regarding treatment of diabetes: compliance with practice guidelines . J Fam Pract 1997 ;44:369-73.

10.

Hetlevik I. , Holmen J. , Midthjell K. Treatment of diabetes mellitus - physicians' adherence to clinical guidelines in Norway . Scand J Primary Health Care 1997;15:193-7.

11.

Weinehall L. , Ohgren B. , Persson M. , Stegmayr B. , Boman K. , Hallmans G. , Lindholm LH High remaining risk in poorly treated hypertension: the "rule of halves" still exists . J Hypertens 2002;20:2081-8.

12.

del Canizo-Gomez FJ , Moreira-Andres MN

Cardiovascular risk factors in patients with type 2 diabetes. Do we follow the guidelines?

Diabetes Res Clin Pract 2004;65:125-33.

13.

Brannstrom I. , Weinehall L. , Persson LA , Wester PO , Wall S. Changing social patterns of risk factors for cardiovascular disease in a Swedish community intervention project . Int J Epidemiol 1993;22:1026-37.

14.

Grant RW , Cagliero E. , Murphy-Sheehy P. , Singer DE , Nathan DM , Meigs JB Comparison of hyperglycemia, hypertension, and hypercholesterolemia management in patients with type 2 diabetes . Am J Med 2002;112:603-9.

15.

Nilsson PM , Theobald H. , Journath G. , Fritz T. Gender differences in risk factor control and treatment profile in diabetes: a study in 229 Swedish primary health care centres . Scand J Primary Health Care 2004;22:27-31.

16.

Evans A. , Tolonen H. , Hense HW , Ferrario M. , Sans S. , Kuulasmaa K. Trends in coronary risk factors in the WHO MONICA project . Int J Epidemiol 2001;30:35-40.

17.

Jansson JH , Boman K. , Messner T. Trends in blood pressure, lipids, lipoproteins and glucose metabolism in the Northern Sweden MONICA project 1986-1999 . Scand J Public Health Suppl 2003;61:43-50.

18.

Larme AC , Pugh JA Attitudes of primary care providers toward diabetes: barriers to guideline implementation . Diabetes Care 1998;21:1391-6.

19.

US Department of Health and Human Services. American Diabetes Association renew campaign to help people with diabetes know their cardiovascular risks, new ADA survey shows many know little about risks of heart disease, stroke . HHS News 2002. Available at: http://www.hhs.gov/news/press/2002pres/20020219.html .

20.

Carroll C. , Naylor E. , Marsden P. , Dornan T.

How do people with type 2 diabetes perceive and respond to cardiovascular risk?

Diabetic Med 2003;20:355-60.

21.

Wilson PW , D'Agostino RB , Sullivan L. , Parise H. , Kannel WB Overweight and obesity as determinants of cardiovascular risk: the Framingham experience . Arch Intern Med 2002;162:1867-72.

22.

Eliasson M. , Lindahl B. , Lundberg V. , Stegmayr B. No increase in the prevalence of known diabetes between 1986 and 1999 in subjects 25-64 years of age in northern Sweden . Diabetic Med 2002;19:874-80.

23.

Kehoe R. , Wu SY , Leske MC , Chylack LT Jr. Comparing self-reported and physician-reported medical history . Am J Epidemiol 1994;139:813-18.

24.

Colditz GA , Martin P. , Stampfer MJ , Willett WC , Sampson L. , Rosner B. , et al. Validation of questionnaire information on risk factors and disease outcomes in a prospective cohort study of women . Am J Epidemiol 1986;123: 894-900.