Abstract
Background/ObjectivesLowering low-density lipoprotein cholesterol (LDLc) in type 2 diabetes mellitus is of paramount importance in preventing cardiovascular disease. However, treatment targets for LDLc are often not reached. We studied the prevalence of LDLc target achievement in a real-life population of type 2 diabetes mellitus patients in secondary care, and investigated whether in those not on target, there is room for intensifying pharmacological and lifestyle management according to current treatment guidelines.Subjects/MethodsWe performed a cross-sectional analysis in the DIAbetes and LifEstyle Cohort Twente-1 (DIALECT-1; n = 450, age 63 ± 9 years, 58% men, diabetes duration 11 (7–18) years). At baseline, we determined plasma LDLc concentration, pharmacological treatment (i.e., statin use), and lifestyle (physical activity and dietary intake). Patients were divided according to LDLc < 1.8, LDLc 1.8–2.5, and LDLc > 2.5 mmol/l. Dietary intake was collected from a validated Food Frequency Questionnaire (177 items) and we determined guideline adherence for different food groups. Physical activity was assessed with the Short Questionnaire to ASsess Health enhancing behavior.ResultsLDLc data were available in 428 type 2 diabetes mellitus patients. LDLc ≤ 2.5 mmol/l was achieved in 317 patients (76%). In total, 76% of patients used statins, in those with LDLc > 2.5 mmol/l, this was 44%. Adherence to lifestyle guidelines was not different between the LDLc groups and was as follows: body mass index 6%, physical activity 59%, vegetables 7%, fruit 28%, legumes 59%, nuts 14%, dairy 19%, fish 36%, tea 8%, fats 66%, red meat 12%, processed meat 2%, alcohol 71%, sweetened beverages 34%, and sodium 12%.ConclusionsIn type 2 diabetes mellitus patients in secondary health care, the target LDLc is achieved by three quarters of patients. Increasing statin treatment could be a first step to improve LDLc. In addition, there are ample opportunities for lifestyle management through increasing adherence to lifestyle guidelines.
Highlights
Type 2 diabetes mellitus is associated with a substantially increased risk for cardiovascular disease (CVD), of up to two times higher than the general population, especially if disease duration is > 10 years[1, 2]
low-density lipoprotein cholesterol (LDLc) data were available in 428 type 2 diabetes mellitus patients
In type 2 diabetes mellitus patients in secondary health care, the target LDLc is achieved by three quarters of patients
Summary
Type 2 diabetes mellitus is associated with a substantially increased risk for cardiovascular disease (CVD), of up to two times higher than the general population, especially if disease duration is > 10 years[1, 2]. Several studies show that in clinical practice, a large proportion (44–67%) of patients with type 2 diabetes mellitus does not achieve the recommended treatment targets[10,11,12], but an integral understanding of where opportunities may lie to improve management are lacking[13]. Whereas some studies on this subject focus on pharmacological management and general lifestyle habits (i.e., body mass index (BMI), smoking, and alcohol), and others on in-depth nutritional habits[14,15,16], an integral approach is warranted, because both pharmacological treatment and dietary composition contribute to clinical outcomes and are part of clinical management. We have shown that for blood pressure management there are numerous opportunities in lifestyle management[17]
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