Cholesterol management of patients with diabetes in a primary care practice-based research network

Objective: To determine the proportion of diabetic patients with and without coronary heart disease (CHD) who attained the American Diabetes Association recommended low-density lipoprotein cholesterol (LDL-C) target level of less than or equal to2.60 mmol/L (less than or equal to100 mg/dL). Study Design: Retrospective cross-sectional study. Methods: Patients were identified by searching an electronic medical record database from March 1997 through March 2001. Search strategies included a problem list entry of diabetes mellitus or CHID, a medication in the antidiabetic or nitrate class, or a glycosylated hemoglobin value of greater than or equal to7.0%. Additional information included patient demographics, last LDL-C level, and use of a lipid-lowering agent. Results: The study identified 10 201 patients (4844 with diabetes only, 1243 with diabetes plus CHID, and 4114 with CHID only). A greater proportion of patients' who had diabetes and CHID attained the LDL-C target goal compared with patients who had diabetes only (32.1% vs 18.1%; P < .001). Furthermore, patients with diabetes plus CHID were more likely to have a LDLC level measured within the past year (50.2% vs 42.5% respectively; P<.001). Multivariate logistic regression analysis revealed several factors associated with LDL-C- goal attainment, including prior history of CHID, lipid-lowering therapy, tight glycemic control, HMO insurance, and a family medicine provider. Conclusion: Although LDL-C goal attainment in patients with diabetes plus CHID was significantly better than that in patients with diabetes only, the prevalence of inadequate control in these high-risk populations is of national concern.