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Health Centers Undertreat CV Risk Factors in Diabetes Patients


 

Undertreatment for hypertension and dyslipidemia is highly prevalent among diabetic patients who receive care at community-based centers, with only a small group having all their cardiovascular risk factors managed, according to an observational Italian study.

The authors wrote that there could be several possible explanations for this outcome, “including the complex and challenging nature of diabetes management and the low reimbursement rate for outpatient visits. … In fact, a short encounter with a high-risk and challenging patient does not adequately provide the time necessary for addressing adherence to complex care behaviors and assessment for optimal therapeutic effectiveness.”

Dr. Furio Colivicchi of the S. Filippo Neri Hospital in Rome and colleagues prospectively evaluated 1,078 type 2 diabetes mellitus patients (571 men and 507 women) with a mean age of 67.6 years to assess how hyperglycemia, hypertension, and dyslipidemia are detected, treated, and controlled in urban community-based diabetic care clinics in Italy. The authors cited the lack of treatment and outcome data for these patients as a reason for conducting the study.

The researchers prospectively collected glycosylated hemoglobin, blood pressure, and cholesterol subfractions values and clinical and medication data to assess cardiovascular risk factor control. The mean time from the initial diagnosis to the inclusion visit was 11.6 years (Diabetes Res. Clin. Pract. 2007;75:176–83).

Despite a 66.6% hypertension prevalence in the study cohort, only 29.6% of patients met the treatment goal of systolic blood pressure less than 130 mm Hg. The goal of diastolic blood pressure less than 80 mm Hg was met in 38.6% of patients, and only 25.5% of patients met the treatment guideline for LDL cholesterol values less than 100 mg/dL.

Glycosylated hemoglobin values less than 7% were recorded in 57.8% of cases; the mean value for glycosylated hemoglobin in the study sample was 6.9%. The authors called these findings “far more satisfactory than those reported in other similar previous surveys, possibly expressing the fact that clinical management of diabetic patients in this setting of urban diabetic care clinics is mainly focused on glycemic control.”

Undertreatment for hypertension and dyslipidemia in community-based centers was “highly prevalent in this survey, and only a very small group of diabetic patients had all cardiovascular risk factors comprehensively addressed,” the authors noted. Consequently, “a high proportion of our patients were noncompliant with European guidelines.”

They added that their results “underscore the major difficulties in following complex guidelines in our present health care system, rather than the lack of enthusiasm among health care providers to rigorously implement recommendations.”

The authors advised their study should be “considered as a baseline measurement and an initial step paving the way for further quality improvement initiatives.”

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