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 an academic medical center and assessed the care they received during an 18-month period. We compared proportions of patients who had hemoglobin A1c (HbA1c) levels, blood pressure, or total cholesterol levels measured; who had been prescribed any drug therapy if HbA1c levels, systolic blood pressure, or low-density lipoprotein (LDL) cholesterol levels exceeded recommended treatment goals; and who had been prescribed greater-than-starting-dose therapy if these values were above those of treatment goals. Results Patients were less likely to have cholesterol levels (76%, N = 455) measured than HbA1c (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 HbA1c (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 HbA1c 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.