Lack of Effect of Guideline Changes on LDL Cholesterol Reporting and Control for Diabetes Visits in the U.S., 1995–2004

  1. Y. Richard Wang, MD, PHD12,
  2. G. Caleb Alexander, MD, MS345 and
  3. David O. Meltzer, MD, PHD3456
  1. 1Public Policy Department, AstraZeneca Pharmaceuticals, Wilmington, Delaware
  2. 2Leonard David Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
  3. 3MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, Illinois
  4. 4Robert Wood Johnson Clinical Scholars Program, University of Chicago, Chicago, Illinois
  5. 5Department of Medicine, University of Chicago Hospitals, Chicago, Illinois
  6. 6Harris School for Public Policy, University of Chicago, Chicago, Illinois
  1. Address correspondence and reprint requests to Y. Richard Wang, MD, PhD, Public Policy Department, AstraZeneca Pharmaceuticals, FOC 3 CE 417, 1800 Concord Pike, Wilmington, DE 19850-5437. E-mail:{at}

We studied the effects of guideline changes on LDL cholesterol reporting and control for diabetes visits compared with coronary heart disease (CHD) visits in the U.S. between 1995 and 2004. In January 1998, the American Diabetes Association (ADA) advocated an LDL cholesterol goal of <100 mg/dl for patients with diabetes (1). Subsequently, in May 2001, the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults published its third report (Adult Treatment Panel III [ATP III]) that designated diabetes as a CHD risk equivalent, with the same LDL cholesterol goal of <100 mg/dl (2).


The publication of the ADA and ATP III guidelines provides an opportunity to assess the effect of guideline changes on LDL cholesterol reporting and control for diabetes visits. The publication of guidelines does not ensure timely communication to the practicing physician let alone the adoption into patient care. As the treatment strategy for CHD remained unchanged (2), we used CHD visits as the control group for the time trends of LDL cholesterol reporting and control.

We used the National Disease and Therapeutic Index (NDTI) (3), an ongoing survey of U.S. office-based physicians conducted by IMS Health providing nationally representative diagnostic and treatment data, to analyze the national trends …

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