Post-Prandial Lipid Levels for Assessing Target Goal Achievement in Type 2 Diabetic Patients Taking Statin

It is inconvenient to perform serum lipid analysis in fasting state in diabetic patients with drug treatment. In patients with statin treatment and Asian diet, it has not been clearly known whether non-fasting values could be used for the clinical decision making in diabetic patients. In this study, fasting and post-prandial plasma lipid profiles of hospitalized type 2 diabetic patients taking statin, were measured in whom standard diabetic breakfast in traditional Korean style were provided. In repeated-measures ANOVA, there were no significant differences among fasting, post-prandial 2 and 4 hr low-density lipoprotein (LDL) and high density lipoprotein (HDL) cholesterol values. When compared to fasting levels, both post-prandial 2 hr and 4 hr LDL cholesterol levels were misclassified as not achieved target goal only in 4% of patients. Post-prandial HDL cholesterol matched with fasting values in women, without exception. In conclusion, the fasting and post-prandial LDL and HDL cholesterol levels are not significantly different each other and can be used in the assessment of achieving target goal in type 2 diabetes taking statin after Korean diet.

Cumplimiento de las metas con reductores del colesterol en pacientes mexicanos: El estudio COMETA México / Cholesterol goal Attainment with Lipid Lowering Drugs: The COMETA Mexico Trial

En un estudio retrospectivo para determinar el porcentaje de pacientes que alcanzan las metas terapéuticas de C-LDL con hipolipemiantes, se seleccionaron 20 especialistas y médicos generales, quienes trabajaron con 120 pacientes y les midieron los lípidos después de por lo menos 12 semanas de tratamiento. Fueron agrupados en tres categorías: grupo A (riesgo absoluto de cardiopatía coronaria a 10 años <10%); grupo B, con riesgo entre 10 y 20%, y grupo C, con riesgo >20%. Los valores meta del C-LDL fueron: <160 mg/dl para el grupo A, <130 para el B y <100 para el C. La edad fue 57 ± 12 años, 59% fueron hombres y 51% del grupo C. De éstos 83% recibió estatinas, 12% fibratos solos y 5% combinaciones. Atorvastatina y Simvastatina fueron los fármacos más utilizados, a dosis promedio moderadas (12 y 27 mg/día). El C-LDL se redujo 25%. En 22% se ajustó la dosis. Alcanzó las metas de C-LDL con la primera dosis (29%) y al final del estudio (42%). Las metas se alcanzaron mejor en los grupos de menor riesgo. No hubo diferencias entre los distintos tipos de médicos. Los datos indican pobre apego a las recomendaciones internacionales e insuficiente alcance de las metas terapéuticas.

In a retrospective study to determine rate of patients attaining therapeutic LDL-C goal values with lipid-lowering drugs, 20 specialists and general practitioners were selected who enrolled 120 patients whose lipids were measured after at least 12 weeks of treatment. They were grouped in three categories: group A (absolute risk of CHD in 10 years <10%); group B, with 10-20% risk, and group C, with >20% risk. Goal LDL-C values were < 160 mg/dL for group A, < 130 for group B, and < 100 for group C Mean age was 57 ± 12 years, 59% were males, and 51% were in group C; 83% took statins, 12% fibrates alone, and 5%, combinations. Atorvastatin and simvastatin were the most used drugs, at medium doses (mean 12 and 27 mg/day). LDL-C was reduced 25%; overall, 22% of patient doses were adjusted. Therapeutic goals were attained in 29% with initial doses and 42% at the end of study. Goalvalues were better attained in groups with lower risk. No differences were noticed among distinct physician categories. Data show poor compliance with international guidelines and insufficient attainment of therapeutic goals.