Control of Cardiovascular Risk Factors in Patients With Diabetes and Hypertension at Urban Academic Medical Centers
- Samy I. McFarlane, MD12,
- Scott J. Jacober, DO5,
- Nathaniel Winer, MD12,
- Jasjeet Kaur, MD34,
- Jonathan P. Castro, MD123,
- MaryLou A. Wui, MD123,
- Agnes Gliwa, MD123,
- Hans Von Gizycki1 and
- James R. Sowers, MD123
- 1Division of Endocrinology, Diabetes and Hypertension, Departments of Medicine and Cell Biology at State University of New York, Health Science Center at Brooklyn, Brooklyn, New York
- 2Kings County Hospital Center, Brooklyn, New York
- 3VA Medical Centers of Brooklyn, Brooklyn, New York
- 4Wayne State University, Detroit, Michigan
- 5VA Medical Center, Detroit, Michigan
Abstract
OBJECTIVE—There are national mandates to reduce blood pressure (BP) to <130/85 mmHg, LDL cholesterol to <100 mg/dl, and HbA1c to <7% and to institute aspirin therapy in patients with diabetes. The objective of this study was to determine the proportion of patients in urban institutions with diabetes and hypertension who meet these treatment goals.
RESEARCH DESIGN AND METHODS—Using American Diabetes Association (ADA) guidelines, we evaluated the control of cardiovascular disease (CVD) risk factors in 1,372 patients receiving medical care at two major urban medical centers in Brooklyn and Detroit. Information was extracted from charts of outpatient clinics.
RESULTS—Of 1,372 active clinic patients with diabetes and hypertension, 1,247 (90.9%) had type 2 diabetes, and 26.7% met the target blood pressure of 130/85 mmHg. A total of 35.5% met the goal LDL cholesterol level of <100 mg/dl, 26.7% had an HbA1c <7%, and 45.6% were on antiplatelet therapy. Only 3.2% of patients met the combined ADA goal for BP, LDL cholesterol, and HbA1c.
CONCLUSIONS—Optimal control of CVD risk factors in adults with diabetes was achieved only in a minority of patients. Results reflect the inherent difficulties in achieving these complex guidelines in our present health care systems.
- ADA, American Diabetes Association
- BP, blood pressure
- CHD, coronary heart disease
- CVD, cardiovascular disease
- DBP, diastolic blood pressure
- HMG, hydroxymethylglutaryl
- NHANES, National Health and Nutrition Examination Study
- SBP, systolic blood pressure
- SUNY, State University of New York
- VAMC, Veteran Affairs Medical Center
- WSU-UHC, Wayne State University–University Health Center
Footnotes
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Address correspondence and reprint requests to James R. Sowers, MD, FACP, Professor of Medicine and Cell Biology, Director, Endocrinology, Diabetes and Hypertension, SUNY Health Science Center at Brooklyn, 450 Clarkson Ave., Box 1205, Brooklyn, NY 11203. E-mail: jsowers{at}netmail.hscbklyn.edu.
Received for publication 14 August 2001 and accepted in revised form 27 December 2001.
S.J.J. is currently affiliated with Eli Lilly, Indianapolis, IN.
A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.
- DIABETES CARE
