HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Erdman, D. M. Articles by Phillips, L. S. Search for Related Content PubMed PubMed Citation Articles by Erdman, D. M. Articles by Phillips, L. S. Social Bookmarking                What's this?

The Impact of Outpatient Diabetes Management on Serum Lipids in Urban African-Americans With Type 2 Diabetes

¹ Grady Health System Atlanta, and the
² Division of Endocrinology and Metabolism, Department of Medicine, Emory University School of Medicine
³ Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, the Centers for Disease Control and Prevention
⁴ Department of Pharmacy Practice, Mercer University, Atlanta, Georgia

OBJECTIVE—Treating dyslipidemia in diabetic patients is essential, particularly among minority populations with increased risk of complications. Because little is known about the impact of outpatient diabetes management on lipid outcomes, we examined changes in lipid profiles in urban African-Americans who attended a structured diabetes care program.

RESEARCH DESIGN AND METHODS—A retrospective analysis of initial and 1-year follow-up lipid values was conducted among patients selected from a computerized registry of an urban outpatient diabetes clinic. The independent effects of lipid-specific medications, glycemic control, and weight loss on serum total cholesterol, LDL cholesterol, HDL cholesterol, and triglyceride levels were evaluated by analysis of covariance and multiple linear regression.

RESULTS—In 345 patients (91% African-American and 95% with type 2 diabetes), HbA_1c decreased from 9.3% at the initial visit to 8.2% at 1 year (P < 0.001); total and LDL cholesterol and triglyceride levels were significantly lower, and HDL cholesterol was higher. After stratifying based on use of lipid-specific therapy, different outcomes were observed. In 243 patients not taking dyslipidemia medications, average total cholesterol, LDL cholesterol, and triglyceride concentrations at 1 year were similar to initial values, whereas in 102 patients receiving pharmacotherapy, these lipid levels were all lower at 1 year relative to baseline (P < 0.001). Mean HDL cholesterol increased regardless of lipid treatment status (P < 0.001). After adjusting for other variables, changes in LDL cholesterol concentration were associated only with use of lipid-specific agents (P = 0.003), whereas improved HbA_1c and weight loss had no independent effect. Lipid therapy, improved glycemic control, and weight loss were not independently related to changes in HDL cholesterol and therefore could not account for the positive changes observed. Use of lipid-directed medications, improvement in glycemic control, and weight loss all resulted in significant declines in triglyceride levels but only improved HbA_1c and weight loss had an independent effect.

CONCLUSIONS—Among urban African-Americans, diabetes management led to favorable changes in HDL cholesterol and triglyceride levels, but improved glycemic control and weight loss had no independent effect on LDL cholesterol concentration. Initiation of pharmacologic therapy to treat high LDL cholesterol levels should be considered early in the course of diabetes management to reach recommended targets and reduce the risk of cardiovascular complications in this patient population.

Abbreviations: ADA, American Diabetes Association • ANCOVA, analysis of covariance • CVD, cardiovascular disease • HMG, hydroxymethylglutaryl

CiteULike    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

				M. E. Peek, A. Cargill, and E. S. Huang Diabetes Health Disparities: A Systematic Review of Health Care Interventions Med Care Res Rev, October 1, 2007; 64(5_suppl): 101S - 156S. [Abstract] [PDF]

				D. C. Ziemer, K. J. Berkowitz, R. M. Panayioto, I. M. El-Kebbi, V. C. Musey, L. A. Anderson, N. S. Wanko, M. L. Fowke, C. W. Brazier, V. G. Dunbar, et al. A Simple Meal Plan Emphasizing Healthy Food Choices Is as Effective as an Exchange-Based Meal Plan for Urban African Americans With Type 2 Diabetes Diabetes Care, June 1, 2003; 26(6): 1719 - 1724. [Abstract] [Full Text] [PDF]