Comparison of hyperglycemia, hypertension, and hypercholesterolemia management in patients with type 2 diabetes

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 all 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-close 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.