The Natural History of LDL Control in Type 2 Diabetes
A prospective study of adherence to lipid guidelines
- Diana Rucker, MD, MSC1,
- Jeffrey A. Johnson, PHD123,
- T.K. Lee, MD1,
- Dean T. Eurich, MSC23,
- Richard Z. Lewanczuk, MD, PHD1,
- Scot H. Simpson, PHARMD, MSC34,
- Ellen L. Toth, MD13 and
- Sumit R. Majumdar, MD, MPH123
- 1Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- 2Department of Public Health Sciences, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- 3Institute of Health Economics, Edmonton, Alberta, Canada
- 4Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada
- Address correspondence and reprint requests to Dr. Sumit R. Majumdar, University of Alberta, 2E3.07 Walter Mackenzie Health Sciences Centre, University of Alberta Hospital, 8440-112th St., Edmonton, Alberta, Canada, T6G 2B7. E-mail: me2.majumdar{at}ualberta.ca
Despite randomized trials repeatedly showing the benefits of lowering LDL cholesterol with hydroxymethylglutaryl (HMG)-CoA reductase inhibitors (statins) (1–3), these medications are suboptimally used in type 2 diabetes (4–10). Although this care gap in type 2 diabetes has been frequently described in cross-sectional studies (6–11), it may be as informative to understand LDL control over time. In particular, there is growing recognition of care gaps in diabetes when comparing urban and academic settings with rural settings (11,12). Therefore, we examined changes over an 18-month period for adherence to guideline-recommended LDL cholesterol targets in a rural cohort with type 2 diabetes and determined the rates and correlates of 1) losing control of LDL cholesterol in those who were initially at target and 2) achieving control of LDL cholesterol in those who were not initially at target.
RESEARCH DESIGN AND METHODS—
The Diabetes Outreach Van Enhancement (DOVE) study was a controlled trial of a multifaceted intervention directed at health care providers to improve the quality of care for rural patients with type 2 diabetes in northern Alberta, Canada. The intervention consisted of an educational outreach (“academic detailing”) service, whereby specialist physicians promoted aggressive cardiovascular risk reduction for diabetes to primary care physicians. The study rationale, design, and outcomes have been previously published (12–16). All subjects provided written consent, and the study was approved by the University of Alberta.
All patients had universal health care coverage and fee-for-service primary care physicians, with the nearest specialists being ∼6 …
