Mithal Ambrish, Majhi Debashish, Shunmugavelu M, Talwarkar Pradeep G, Vasnawala Hardik, Raza Ammar S
Chairman, Division of Endocrinology and Diabetes, Medanta The Medicity, Gurgaon, Haryana, India.
Consultant Diabetologist and Endocrinologist, Calcutta Diabetes and Endocrine Foundation, Kolkata, West Bengal, India.
Indian J Endocrinol Metab. 2014 Sep;18(5):642-7. doi: 10.4103/2230-8210.139220.
India leads the world with largest number of diabetic patients and is often referred to as the diabetes capital of the world. Diabetic dyslipidemia in India is one of the main cause for Coronary Artery Disease (CAD) mortality. Although diabetes continues to be a major lifestyle condition in India, there is a lack of studies in India on whether dyslipidemia in Indian diabetics is being adequately controlled. Our study provides critical insights into the insights into proportion of diabetes patients achieving lipid goal in India.
The primary objective of our study was to assess the control of dyslipidemia in the Indian diabetic population treated with lipid lowering drugs (LLDs), as per American Diabetes Association (ADA) 2010 guidelines.
The study was carried out in a real world Indian clinical setting involving 178 sites. This is a multicenter, noninterventional, and cross-sectional observational study.
A total of 5400 adult subjects with established type-2 diabetes mellitus (T2DM) and dyslipidemia were recruited for the study. Patients in the study were on LLD at a stable dose for at least last 3 months before the designated study visit. Routine lipid profile tests were conducted for all patients.
Descriptive statistics was used to analyze qualitative and discrete variables. Chi-square test and t-test were conducted to assess the existence of statistically significant association between the variables.
A total of 5400 patients with T2DM from 178 centers across India were recruited. Out of the total population, 56.75% (N = 3065) of them were males. Primary end-point of low-density lipoprotein cholesterol (LDL-C) level below ADA 2010 target was achieved in a total of 48.74% (N = 2632) patients. Gender was significantly associated with lipid levels and age was significantly (P < 0.05) correlated with all lipid levels. Control rates of other lipid parameters like high-density lipoprotein cholesterol, triglyceride, and total cholesterol in the study were 60.48% (N = 3236), 57.54% (N = 3107), and 92.24% (N = 4981) respectively. Among those with overt cardiovascular disease (CVD), target LDL-C level of < 70 mg/dL was achieved in 22.87% (70 out of 306) patients. The LDL-C levels of 49.03% (N = 1768) patients who were on statin therapy were within target levels, while 53.46% (N = 634) patients who were on statin and their combinations with other LLDs had their LDL-C levels within the stipulated range.
This study has reveled that dyslipidemia control in Indian T2DM patients is very poor with almost half of them not reaching their LDL -C goal. Dyslipidemia being one of the main risk factors for CVD in T2DM patients there is a need to treat dyslipidemia aggressively to reduce risk of future CV events.
印度糖尿病患者数量居世界首位,常被称为“世界糖尿病之都”。印度的糖尿病血脂异常是冠状动脉疾病(CAD)死亡的主要原因之一。尽管糖尿病在印度仍然是一种主要的生活方式疾病,但印度缺乏关于糖尿病患者血脂异常是否得到充分控制的研究。我们的研究为了解印度糖尿病患者实现血脂目标的比例提供了重要见解。
我们研究的主要目的是根据美国糖尿病协会(ADA)2010年指南,评估接受降脂药物(LLD)治疗的印度糖尿病患者的血脂异常控制情况。
该研究在印度178个地点的真实临床环境中进行。这是一项多中心、非干预性横断面观察研究。
共招募了5400名确诊为2型糖尿病(T2DM)和血脂异常的成年受试者。研究中的患者在指定研究访视前至少3个月一直服用稳定剂量的LLD。对所有患者进行常规血脂检测。
描述性统计用于分析定性和离散变量。进行卡方检验和t检验以评估变量之间是否存在统计学上的显著关联。
共招募了来自印度178个中心的5400例T2DM患者。在总人口中,56.75%(N = 3065)为男性。共有48.74%(N = 2632)的患者达到了低密度脂蛋白胆固醇(LDL-C)水平低于ADA 2010目标值这一主要终点。性别与血脂水平显著相关,年龄与所有血脂水平均显著相关(P < 0.05)。研究中其他血脂参数如高密度脂蛋白胆固醇、甘油三酯和总胆固醇的控制率分别为60.48%(N = 3236)、57.54%(N = 3107)和92.24%(N = 4981)。在患有明显心血管疾病(CVD)的患者中,22.87%(306例中的70例)患者的目标LDL-C水平<70mg/dL。接受他汀类药物治疗的患者中,49.03%(N = 1768)的LDL-C水平在目标范围内,而同时接受他汀类药物及其与其他LLD联合治疗的患者中,53.46%(N = 634)的LDL-C水平在规定范围内。
本研究表明,印度T2DM患者的血脂异常控制非常差,几乎一半患者未达到LDL-C目标。血脂异常是T2DM患者发生CVD的主要危险因素之一,因此需要积极治疗血脂异常以降低未来心血管事件的风险。