Adherence to dyslipidemia treatment guidelines in diabetic patients

Adherence to Dyslipidemia Treatment Guidelines in Diabetic Patients Richard Reichleya, RPh, Peggy S. McKinnonc, PharmD, Terry Seatond, PharmD, Laura Noirotb, BS, Wm. C. Dunagana,b, MD, and Thomas C. Baileya,b, MD a BJC HealthCare, Center for Healthcare Quality & Effectiveness; bWashington University School of Medicine, Dept of Internal Medicine; cBarnes-Jewish Hospital, Pharmacy Dept; d St. Louis College of Pharmacy, St. Louis, MO Using a previously described computer algorithm to prospectively identify diabetics, we observed the adherence to published guidelines for treatment of dyslipidemia in diabetics. Despite national guidelines, dyslipidemia remains widely undertreated. Further interventions are needed to improve lipid-lowering treatment in appropriate candidates.

independently associated with appropriate treatment were: male gender, non-white race, cardiovascular service, and co-morbidities of stroke, CAD, and COPD; HTN was negatively associated (data not shown). Table 1. Characteristics of diabetics with LDL >100 Characteristic

n=511

Introduction

Current treatment guidelines1 consider diabetes mellitus (DM) a coronary heart disease (CHD) riskequivalent condition, with a goal LDL-c of 100 mg/dL.

Results Of 2546 admissions, 408 (16%) were incorrectly identified as DM by the algorithm. Of the 2138 diabetic admissions, a recent LDL-c test was available for 1082 (51%), activating the administrative protocol for the remaining patients. As a result, 2028 (95%) of the diabetic patients had a recent LDL-c result. LDL-c was > 100 mg/dL in 511 (24%), < 100 mg/dL in 1517 (71%), and 110 (5%) had no LDL-c result. Of the 511 not achieving the LDL-c goal, 221 (43%) were on a statin prior to admission, 266 (52%) were discharged on a statin, and 10 (2%) had a statin contraindication. Of the 221 already on a statin, 20 did not have discharge prescription to continue and only one had a known contraindication. Univariate characteristics of diabetics with LDL-c > 100 mg/dL are shown in Table 1. By logistic regression, characteristics

No Statin Statin n=235 (46%) n=276 (54%)

Age, mean yrs 59.7 Gender Female (n=298) 153 (51%) Male (n=213) 86 (40%) Race/ethnicity White (n=226) 126 (56%) non-White (n=285) 112 (39%) Service Cardiovasc(n=126) 39 (31%) Medicine (n=350) 184 (53%) Vasc Surg (n=35) 16 (46%) Co-morbidities CAD (n=266) 96 (36%) COPD (n=97) 34 (35%) CHF (n=210) 85 (40%) Stroke (n=34) 10 (29%) HTN (n=268) 204 (76%)

P*

60.5

0.5916

145 (49%) 127 (60%)

0.0486

100 (44%) 173 (61%)

0.0003

87 (69%) 166 (47%) 19 (54%)