Hosokawa Masaya, Hamasaki Akihiro, Nagashima Kazuaki, Harashima Shinichi, Toyoda Kentaro, Fujita Yoshihito, Harada Norio, Nakahigashi Yuko, Fujimoto Shimpei, Inagaki Nobuya
Department of Diabetes, Endocrinology and Nutrition, Graduate School of Medicine, Kyoto University, Japan.
Intern Med. 2013;52(21):2409-15. doi: 10.2169/internalmedicine.52.0599.
The management of diabetes mellitus includes controlling the blood glucose level, body weight, blood pressure and serum lipid level. The coexistence of diabetes and a high low-density lipoprotein cholesterol (LDL-C) level promotes atherosclerosis of the coronary arteries and increases the risk of coronary artery disease (CAD). We compared the rates of attainment of LDL-C goals in type 2 diabetes patients receiving primary and secondary prevention therapy, the former without a history of CAD and the latter with a history of CAD. Because patients receiving secondary prevention are at greater risk of coronary events, LDL-C management is especially important in this group. This study was designed to determine how frequently diabetic patients attain their LDL-C goals and identify the reasons for the lack of attainment.
The groups were distinguished according to the patients' medical records. Contributory factors for the patients not achieving their goals were recorded in a questionnaire filled out by each patient's physician.
The overall attainment rate in both groups was 61%. The most frequent impediment in both groups was "an LDL-C level above or below the goal at every hospital visit" followed by "continuously sufficient effects of dietary therapy only" and the "management of LDL-C by other departments or hospitals," the latter reflecting the increasing problems of polydisease and polypharmacy in diabetes care.
Polydisease and polypharmacy issues in diabetes patients with a history of CAD constitute a growing barrier to medication adherence and the attainment of treatment goals.
糖尿病管理包括控制血糖水平、体重、血压和血脂水平。糖尿病与高低密度脂蛋白胆固醇（LDL-C）水平并存会促进冠状动脉粥样硬化，并增加冠心病（CAD）风险。我们比较了接受一级预防治疗（既往无CAD病史）和二级预防治疗（既往有CAD病史）的2型糖尿病患者实现LDL-C目标的比率。由于接受二级预防的患者发生冠状动脉事件的风险更高，因此LDL-C管理在该组中尤为重要。本研究旨在确定糖尿病患者达到LDL-C目标的频率，并找出未达标的原因。
根据患者病历区分组别。未实现目标的患者的促成因素由每位患者的医生填写在一份问卷中记录。
两组的总体达标率均为61%。两组中最常见的障碍是“每次就诊时LDL-C水平高于或低于目标值”，其次是“仅饮食治疗持续有效”以及“由其他科室或医院进行LDL-C管理”，后者反映了糖尿病护理中多病共存和多药联用问题日益严重。
有CAD病史的糖尿病患者的多病共存和多药联用问题对药物依从性和治疗目标实现构成了越来越大的障碍。
