Department of Endocrinology and Metabolism, Erciyes University, School of Medicine, Kayseri, Turkey.
Department of Endocrinology and Metabolism, University of Health Sciences, Gulhane School of Medicine, Ankara, Turkey.
Lipids Health Dis. 2020 Nov 11;19(1):237. doi: 10.1186/s12944-020-01408-2.
Attaining acceptable levels of LDL Cholesterol (LDL-C) significantly improves cardiovascular (CV) outcomes in patients with type 2 diabetes mellitus (T2DM). The LDL-C target attainment and the characteristics of patients attaining these targets were investigated in this study. Furthermore, the reasons for not choosing statins and the physicians' attitudes on the treatment of diabetic dyslipidemia were also examined.
A nationwide, cross-sectional survey was conducted in tertiary centers for diabetes management. Adult patients with T2DM, who were under follow-up for at least a year in outpatient clinics, were consecutively enrolled for the study. LDL-C goals were defined as below 70 mg/dL for patients with macrovascular complications or diabetic nephropathy, and below 100 mg/dL for other patients. Data about lipid-lowering medications were self-reported.
A total of 4504 patients (female: 58.6%) were enrolled for the study. The mean HbA1c and diabetes duration was 7.73 ± 1.74% and 10.9 ± 7.5 years, respectively. The need for statin treatment was 94.9% (n = 4262); however, only 42.4% (n = 1807) of these patients were under treatment, and only 24.8% (n = 448) of these patients achieved LDL-C targets. The main reason for statin discontinuation was negative media coverage (87.5%), while only a minority of patients (12.5%) mentioned side effects. Physicians initiated lipid-lowering therapy in only 20.3% of patients with high LDL-C levels. It was observed that the female gender was a significant independent predictor of not attaining LDL-C goals (OR: 0.70, 95% CI: 0.59-0.83).
Less than 50 % of patients with T2DM who need statins were under treatment, and only a quarter of them attained their LDL-C targets. There exists a significant gap between the guideline recommendations and the real-world evidence in the treatment of dyslipidemia in T2DM.
在 2 型糖尿病（T2DM）患者中，达到可接受的 LDL 胆固醇（LDL-C）水平可显著改善心血管（CV）结局。本研究调查了 LDL-C 目标达标情况以及达到这些目标的患者特征。此外，还研究了未选择他汀类药物的原因以及医生对糖尿病血脂异常治疗的态度。
在糖尿病管理的三级中心进行了一项全国性的横断面调查。连续纳入在门诊接受至少一年随访的 T2DM 成年患者进行研究。将 LDL-C 目标定义为有大血管并发症或糖尿病肾病的患者 LDL-C<70mg/dL，其他患者 LDL-C<100mg/dL。降脂药物的数据为自我报告。
共纳入 4504 例患者（女性占 58.6%）。平均 HbA1c 和糖尿病病程分别为 7.73±1.74%和 10.9±7.5 年。需要他汀类药物治疗的患者占 94.9%（n=4262）；然而，仅有 42.4%（n=1807）的患者接受治疗，仅有 24.8%（n=448）的患者达到 LDL-C 目标。他汀类药物停药的主要原因是负面媒体报道（87.5%），而只有少数患者（12.5%）提到副作用。对于 LDL-C 水平较高的患者，只有 20.3%的医生开始进行降脂治疗。研究观察到，女性是 LDL-C 不达标的独立显著预测因素（OR：0.70，95%CI：0.59-0.83）。
需要他汀类药物治疗的 T2DM 患者中，不足 50%的患者接受治疗，仅有四分之一的患者达到 LDL-C 目标。T2DM 患者血脂异常的治疗在指南推荐与真实世界证据之间存在显著差距。
