Diabetes Metab J.  2011 Dec;35(6):628-636. 10.4093/dmj.2011.35.6.628.

Low Density Lipoprotein Cholesterol Target Goal Attainment Rate and Physician Perceptions about Target Goal Achievement in Korean Patients with Diabetes

• Hwang JY
• Jung CH
• Lee WJ
• Park CY
• Kim SR
• Yoon KH
• Lee MK
• Park SW
• Park JY

• KMID: 2280731
• DOI: http://doi.org/10.4093/dmj.2011.35.6.628

Abstract

BACKGROUND
This study aims to investigate the discrepancy between clinicians' perceptions and actual achievement rates of low density lipoprotein cholesterol (LDL-C) in Korean patients with diabetes according to updated American Diabetes Association (ADA)/American College of Cardiology Foundation (ACC) recommendations.
METHODS
This is a multi-center, retrospective, non-interventional, observational study. Diabetic patients aged 18 years or older were eligible if they had been diagnosed with hypercholesterolemia or were receiving a lipid-lowering therapy between May 2010 and August 2010. The information was obtained by reviewing medical records and using a self-completed questionnaire to examine physician perceptions.
RESULTS
A total of 2,591 subjects who satisfied the inclusion criteria were enrolled. Highest-risk and high-risk patients accounted for 61.9% and 38.1% of the patients, respectively. Although most (96.3%) underwent a statin monotherapy or a statin-based combination therapy, just 47.4% of patients attained the LDL-C target. However, the physicians' perceptions on target achievement rate (70.6%) were different from the actual results (47.4%). Many patients (65.3%) remained on the starting doses of statins, despite evidence of poor achievement of lipid goals.
CONCLUSION
Only less than half of patients with diabetes attained the LDL-C goal. The surveys showed that poor physician performance might be due to the lack of recognition on ADA/ACC consensus causing a low LDL-C target attainment rate. Therefore, changes in doctor perception are needed to attain target LDL-C level and reduce cardiovascular risk in Korean patients with diabetes.

Keyword

Diabetes mellitus, type 2; Hypercholesterolemia; Surveys

MeSH Terms

Achievement
Aged
Cardiology
Cholesterol
Cholesterol, LDL
Consensus
Diabetes Mellitus, Type 2
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Hypercholesterolemia
Lipoproteins
Medical Records
Retrospective Studies
Surveys and Questionnaires
Cholesterol
Cholesterol, LDL
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Lipoproteins

Figure

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  Fig. 1 Enrollment of diabetic patients with hypercholesterolemia.

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  Fig. 2 Low density lipoprotein cholesterol target attainment rates according to the 2008 American Diabetes Association (ADA)/American College of Cardiology Foundation (ACC) consensus statement.

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  Fig. 3 Reduction Framingham risk score according to decrease of low density lipoprotein cholesterol level. aP<0.05 by Student's t-test, bP<0.05 by paired t-test.

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  Fig. 4 Physician treatment strategies to achieve target goals analyzed (A) by chart review, (B) by physicians' answers to a survey. MA, multiple answers.

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  Fig. 5 The discrepancy between physicians' perception of low density lipoprotein cholesterol (LDL-C) goal attainment and actual results according to the 2008 American Diabetes Association (ADA)/American College of Cardiology Foundation (ACC) guidelines.

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  Fig. 6 Patterns of physicians' adherence to guideline. NCEP, National Cholesterol Education Program; ATP III, Adult Treatment Panel III; ADA, American Diabetes Association; ACC, American College of Cardiology Foundation; KDA, Korean Diabetes Association; MA, multiple answers; SA, single answers.

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