1 型糖尿病和 2 型糖尿病中的低密度脂蛋白胆固醇和非高密度脂蛋白胆固醇：大型德奥糖尿病登记处的血脂目标达标情况。

Low-density lipoprotein cholesterol and non-high-density lipoprotein cholesterol in type 1 diabetes and type 2 diabetes: Lipid goal attainment in a large German-Austrian diabetes registry.

机构信息

Department of Medicine I, University Hospital Aachen, Aachen, Germany.

Imperial Centre for Cardiovascular Disease Prevention, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK.

出版信息

Diabetes Obes Metab. 2023 Dec;25(12):3700-3708. doi: 10.1111/dom.15264. Epub 2023 Sep 11.

DOI:10.1111/dom.15264

PMID:37694759

Abstract

AIM

To assess the implementation of the 2019 European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) guideline recommendations for lipid-lowering therapies among more than 30 000 patients with type 1 diabetes (T1D) and type 2 diabetes (T2D) in a German and Austrian registry from 2020 to 2022.

MATERIALS AND METHODS

Registry data from 2020 and 2021 of 32 170 adult patients (8314 patients with T1D and 23 856 with T2D) were stratified according to the 2019 ESC/EAS risk categories, and guideline-based low-density lipoprotein cholesterol (LDL-C) and non-high-density lipoprotein cholesterol (non-HDL-C) goal attainment was analysed.

RESULTS

In patients with T1D (median age 38.35 [20.51-57.13] years), overall statin use was 19.3%, ezetimibe use was 2.2% and the use of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors or fibrates was less than 1%. In patients with T2D (median age 68.76 [58.86-78.39] years), 45.7% received statins, 3.4% received ezetimibe, and fibrates and PCSK9 inhibitors were used by 1% and 0.1%, respectively. Among patients with T1D, 6.16% reached their risk-based recommended LDL-C goal of less than 55 mg/dL (very high risk), 10.97% of less than 70 mg/dL (high risk), and 69.50% of less than 100 mg/dL (moderate risk), respectively. In patients with T2D, 11.81% reached their risk-based goal of LDL-C less than 55 mg/dL, 16.25% of less than 70 mg/dL, and 51.33% of less than 100 mg/dL. Non-HDL-C goals were reached more often, with 15.3%, 25.52% and 91.61% in patients with T1D and 18.56%, 17.96% and 82.30% in patients with T2D for very high, high and moderate risk, respectively.

CONCLUSION

Approximately 2 years after publication of the guidelines, LDL-C and non-HDL-C goal attainment was rarely achieved in patients with T1D and T2D with a high or very high cardiovascular risk.

摘要

目的

评估在德国和奥地利的一个登记处，超过 30000 例 1 型糖尿病（T1D）和 2 型糖尿病（T2D）患者中，2019 年欧洲心脏病学会（ESC）/欧洲动脉粥样硬化学会（EAS）降脂治疗指南建议的实施情况。

材料和方法

根据 2019 年 ESC/EAS 风险类别，对 2020 年和 2021 年登记处的 32170 名成年患者（8314 名 T1D 患者和 23856 名 T2D 患者）的数据进行分层，并分析基于指南的低密度脂蛋白胆固醇（LDL-C）和非高密度脂蛋白胆固醇（非-HDL-C）达标情况。

结果

在 T1D 患者（中位年龄 38.35[20.51-57.13]岁）中，他汀类药物的总体使用率为 19.3%，依折麦布使用率为 2.2%，使用前蛋白转化酶枯草溶菌素 9（PCSK9）抑制剂或贝特类药物的患者不到 1%。在 T2D 患者（中位年龄 68.76[58.86-78.39]岁）中，45.7%接受他汀类药物治疗，3.4%接受依折麦布治疗，1%和 0.1%分别使用贝特类药物和 PCSK9 抑制剂。在 T1D 患者中，分别有 6.16%、10.97%和 69.50%达到了基于风险的 LDL-C 目标值<55mg/dL（极高风险）、<70mg/dL（高风险）和<100mg/dL（中风险）。在 T2D 患者中，分别有 11.81%、16.25%和 51.33%达到了基于风险的 LDL-C 目标值<55mg/dL、<70mg/dL 和<100mg/dL。非-HDL-C 目标值的达标率更高，T1D 患者分别有 15.3%、25.52%和 91.61%，T2D 患者分别有 18.56%、17.96%和 82.30%达到极高、高和中风险。