Achieving triple treatment goals in multi-ethnic Asian patients with type 2 diabetes mellitus in primary care

@#Introduction: Achieving optimal glycated hemoglobin (HbA1c), blood pressure (BP), and LDLCholesterol (LDL-C) in patients mitigates macro- and micro-vascular complications, which is the key treatment goal in managing type 2 diabetes mellitus (T2DM). This study aimed to determine the proportion of patients in an urban community with T2DM and the above modifiable conditions attaining triple vascular treatment goals based on current practice guidelines. Methods: A questionnaire was distributed to adult Asian patients with dyslipidemia at two primary care clinics (polyclinics) in northeastern Singapore. The demographic and clinical data for this sub-population with both T2DM and dyslipidemia were collated with laboratory and treatment information retrieved from their electronic health records. The combined data was then analyzed to determine the proportion of patients who attained triple treatment goals, and logistic regression analysis was used to identify factors associated with this outcome. Results: 665 eligible patients [60.5% female, 30.5% Chinese, 35% Malays, and 34.4% Indians] with a mean age of 60.6 years were recruited. Of these patients, 71% achieved LDL-C ≤2.6 mmol/L, 70.4% had BP <140/90 mmHg, and 40.9% attained HbA1c ≤7%. Overall, 22% achieved the triple treatment goals for glycemia, BP, and LDL-C control. The major determinants were the number of diabetic medications and intensity of statin therapy. Conclusion: Eight in ten patients with T2DM failed to achieve concurrent glycemic, BP, and LDL-C treatment goals, subjecting them to risks of vascular complications. Primary healthcare professionals can mitigate these risks by optimizing therapeutic treatment to maximize glycemia, dyslipidemia, and BP control.

Manejo poblacional de las dislipidemias primarias / Population management of primary dyslipidemia

Estudios epidemiológicos revelan una relación continua, gradual y positiva, entre los niveles plasmáticos de colesterol total, colesterol-LDL y la presencia de eventos y mortalidad cardiovascular. En Chile, la Encuesta Nacional de Salud del año 2003, realizada con una muestra representativa de la población chilena mayor de 17 años (N = 3619; 45,5 por ciento hombres y 55,5 por ciento mujeres), reveló una prevalencia de colesterol total elevado (> 200 mg/dl) de un 35,4 por ciento (35,1 por ciento hombres y 35,6 por ciento mujeres).Un 6,6 por ciento de los mayores de 17 años se encuentra en situación de riesgo cardiovascular máximo en base a la evaluación de factores de riesgo (riesgo cardiovascular superior al 20 por ciento de acuerdo con el modelo de Framingham). Estudios clínicos señalan que al enfocar las intervenciones en una disminución del colesterol LDL en pacientes con hipercolesterolemia se reduce la morbimortalidad derivada de la cardiopatía coronaria. Se describen los distintos elementos y en quienes realizar un screening de los lípidos plasmáticos, se señalan las metas de los distintos componentes del perfil lipídico y un enfoque práctico que contempla los lineamientos generales para diagnosticar y tratar las dislipidemias. Se mencionan dos subgrupos que requieren un enfoque particular (población pediátrica y mayores de 65 años). Se revisan las distintas opciones farmacológicas de tratamiento y se discute la importancia de optimizar no sólo los niveles de colesterol LDL, sino que también la necesidad de conseguir las metas de colesterol HDL

Epidemiological studies show a continuing, gradual and positive relationship between plasma levels of total cholesterol, LDL-cholesterol and the presence of cardiovascular events and mortality. In Chile, the 2003 National Health Survey, carried out with a representative sample of the Chilean population over 17 years old (N = 3619; 45.5 percent men and 55.5 percent female), revealed a prevalence of elevated total cholesterol (> 200mg/dl) of 35.4 percent (35.1 percent men and 35.6 percent women). 6.6 percent of the adult population has a maximum cardiovascular risk, based on risk factors assessment (cardiovascular risk > 20 percent according to Framingham model). Clinical studies suggest that by focusing interventions on a decrease of LDL-cholesterol inhypercholesterolemic patients, morbimortality resulting fromCoronary Heart Disease is decreased. Different elements of plasma lipids and on whom to perform a screening are described. The goals of the various components of the lipid profile are identified, as well as a practical approach that provides general guidelines to address and treat dyslipidemia. Two subgroups that require a particular approach (pediatric and over 65 years old population) are mentioned. Pharmacological treatment options are reviewed, and the importance of optimizing not only LDL-cholesterol levels, but also the need to achieve HDL-cholesterol goals, is discussed