Lack of Goal Attainment Regarding the Low-density Lipoprotein Cholesterol Level in the Management of Type 2 Diabetes Mellitus
Lack of Goal Attainment Regarding the Low-density Lipoprotein Cholesterol Level in the Management of Type 2 Diabetes Mellitus
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DOI：
10.2169/internalmedicine.52.0599
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发表时间：
2013-01-01
影响因子：
1.2
通讯作者：
Inagaki, Nobuya
中科院分区：
文献类型：
--
作者：
Hosokawa, Masaya;Hamasaki, Akihiro;Inagaki, Nobuya
目的糖尿病的管理包括控制血糖水平、体重、血压和血脂水平。糖尿病和高低密度脂蛋白胆固醇（LDL-C）水平的共存会促进冠状动脉粥样硬化，并增加冠状动脉疾病（CAD）的风险。我们比较了接受一级和二级预防治疗的 2 型糖尿病患者 LDL-C 目标的实现率，前者没有 CAD 病史，后者有 CAD 病史。由于接受二级预防的患者发生冠状动脉事件的风险更大，因此 LDL-C 管理在该群体中尤为重要。本研究旨在确定糖尿病患者达到 LDL-C 目标的频率，并找出未达到 LDL-C 目标的原因。方法根据患者的病历进行分组。每位患者的医生填写的调查问卷中记录了导致患者未实现目标的因素。结果两组的总体达标率为61%。两组中最常见的障碍是“每次医院就诊时 LDL-C 水平高于或低于目标”，其次是“仅饮食治疗持续产生足够的效果”和“其他科室或医院对 LDL-C 的管理”，后者反映了糖尿病护理中日益严重的多重疾病和多重用药问题。结论 对于有 CAD 病史的糖尿病患者，多重疾病和多重用药问题对药物依从性和实现治疗目标构成了越来越大的障碍。
Objective The management of diabetes mellitus includes controlling the blood glucose level, body weight, blood pressure and serum lipid level. The coexistence of diabetes and a high low-density lipoprotein cholesterol (LDL-C) level promotes atherosclerosis of the coronary arteries and increases the risk of coronary artery disease (CAD). We compared the rates of attainment of LDL-C goals in type 2 diabetes patients receiving primary and secondary prevention therapy, the former without a history of CAD and the latter with a history of CAD. Because patients receiving secondary prevention are at greater risk of coronary events, LDL-C management is especially important in this group. This study was designed to determine how frequently diabetic patients attain their LDL-C goals and identify the reasons for the lack of attainment.Methods The groups were distinguished according to the patients' medical records. Contributory factors for the patients not achieving their goals were recorded in a questionnaire filled out by each patient's physician.Results The overall attainment rate in both groups was 61%. The most frequent impediment in both groups was "an LDL-C level above or below the goal at every hospital visit" followed by "continuously sufficient effects of dietary therapy only" and the "management of LDL-C by other departments or hospitals," the latter reflecting the increasing problems of polydisease and polypharmacy in diabetes care.Conclusion Polydisease and polypharmacy issues in diabetes patients with a history of CAD constitute a growing barrier to medication adherence and the attainment of treatment goals.