Abstract
BackgroundLack of treatment initiation or intensification might explain why some patients with type 2 diabetes do not reach target goals. The objective is to assess trends in risk factor treatment, and identify determinants for medication adjustments in patients with uncontrolled hypertension and/or hyperlipidemia.MethodsWe conducted a cohort study using data from the Zwolle Outpatient Diabetes project Integrated Available Care (ZODIAC)-study in The Netherlands. Management of hypertension and hyperlipidemia was assessed yearly from 1998–2004 by measuring the percentage of patients receiving a treatment initiation or intensification among all patients with elevated risk factor levels. Generalized estimating equation analyses were performed.ResultsDuring the study period, the percentage of patients with an elevated total cholesterol/high-density lipoproteins ratio (>6) decreased considerably (from 29% to 4%) whereas the percentage of hypertensive patients decreased only slightly (≥ 150/85 mmHg; from 58% to 51%). Initiation of lipid-lowering therapy and intensification of antihypertensive therapy was higher in more recent years. However, still two-third of patients with insufficiently controlled blood pressure in 2003 did not receive an initiation or intensification of antihypertensive treatment in the following year. Treatment changes were mainly determined by elevated levels of the corresponding risk factor. We did not observe increased initiation rates for lipid-lowering therapy in patients with both hypertension and hyperlipidemia.ConclusionHypertension and hyperlipidemia management in type 2 diabetes patients has improved in the past decade but further improvement is possible. Greater effort is needed to stimulate medication adjustments in patients with insufficiently controlled hypertension and combined risk factors.
Highlights
Lack of treatment initiation or intensification might explain why some patients with type 2 diabetes do not reach target goals
Clinical trials in patients with type 2 diabetes convincingly demonstrated that cholesterol reduction and tight blood pressure control reduce the risk of major cardiovascular events [3,4,5]
The objectives of the present study were (1) to examine trends in initiation and intensification of lipid-lowering and antihypertensive drug therapy among type 2 diabetes patients, and (2) to analyze factors associated with these drug regime changes, in particular looking at combined risk factors
Summary
Lack of treatment initiation or intensification might explain why some patients with type 2 diabetes do not reach target goals. It has been shown that increasing numbers of diabetes mellitus patients are nowadays tested for relevant risk factors, much smaller percentages reach target goals [10,11,12]. Observational studies so far, have focussed mainly on the influence of single elevated risk factors on treatment modifications [11,13,14] These studies have only looked at changes in drug regimes over short periods of time, not allowing for the assessment of trends. It is not clear whether treatment of multiple risk factors in patients with diabetes has intensified over the past years
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