Influence of Elevated Cardiometabolic Risk Factor Levels on Treatment Changes in Type 2 Diabetes

  1. Jaco Voorham, MSC123,
  2. Flora M. Haaijer-Ruskamp, PHD13,
  3. Ronald P. Stolk, MD, PHD23,
  4. Bruce H.R. Wolffenbuttel, MD, PHD4,
  5. Petra Denig, PHD13 and
  6. the Groningen Initiative to Analyze Type 2 Diabetes Treatment (GIANTT) Group*
  1. 1Clinical Pharmacology, University of Groningen, Groningen, The Netherlands
  2. 2Epidemiology, University of Groningen, Groningen, The Netherlands
  3. 3Graduate School for Health Research, University of Groningen, Groningen, The Netherlands
  4. 4Endocrinology, University of Groningen, Groningen, The Netherlands
  1. Address correspondence and reprint requests to J. Voorham, University Medical Center Groningen, Epidemiology, POB 30001, 9700RB Groningen, Netherlands. E-mail: j.voorham{at}epi.umcg.nl

Abstract

Undertreatment of risk factors in patients with type 2 diabetes is common. We assessed the influence of elevated levels of blood pressure, total cholesterol, and A1C on decisions of Dutch general practitioners to change drug treatment in a cohort of 3,029 patients during a 1-year period. Respectively, 58, 71, and 21% of patients remained untreated despite poor blood pressure, lipid levels, and glycemic control. Of poorly controlled but already drug-treated patients, 52% did not receive intensification for antihypertensive medication, 81% not for lipid-lowering medication, and 43% not for glucose-lowering medication. We observed a significantly lower treatment intervention rate in moderately than in poorly controlled patients for blood pressure. This was not seen for decisions on cholesterol or A1C results. The low overall action rates observed for blood pressure and especially lipid management cannot sufficiently be explained by the use of treatment thresholds higher than those indicated by guidelines.

Footnotes

  • Published ahead of print at http://care.diabetesjournals.org on 10 December 2007. DOI: 10.2337/dc07-1043.

  • *

    ↵* A complete list of the members of the GIANTT Group can be found in the appendix.

  • The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C Section 1734 solely to indicate this fact.

    • Accepted December 4, 2007.
    • Received June 1, 2007.
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  1. Published online before print December 10, 2007, doi: 10.2337/dc07-1043 Diabetes Care March 2008 vol. 31 no. 3 501-503
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