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Cholestabetes Medical Practice Activity (MPA): Overcoming Treatment Inertia in Diabetes

Research Article

Cholestabetes Medical Practice Activity (MPA): Overcoming Treatment Inertia in Diabetes


Anatoly Langer1,2*, Mary Tan1, Lianne Goldin1, Daniel Ngui3, Vincent Woo4 and Lawrence A Leiter2,5

1Canadian Heart Research Centre, Toronto, Ontario, Canada
2St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
3Fraser Street Medical, Vancouver, British Columbia, Canada
4Section of Endocrinology and Metabolism, University of Manitoba, Manitoba, Canada
5Division of Endocrinology & Metabolism, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, University of Toronto, Ontario, Canada

*Corresponding author: Anatoly Langer, Canadian Heart Research Centre, 259 Yorkland Road, North York, Ontario, Canada, Tel: +1 4169996264; Email: langera@CHRC.net

Received: June 22, 2017; Accepted: September 14, 2017; Published: September 29, 2017


Background: The objective of this study was to assess the care gap in the management of risk factors among high cardiovascular risk patients with type 2 Diabetes Mellitus (DM) who were not at guidelines recommended A1C and LDL-C target despite first line therapy.

Methods: A total of 82 primary care physicians enrolled 586 patients with DM, high risk based on Framingham score, LDL-C > 2.0 mmol/L despite optimal statin therapy, and A1C > 7.0% despite metformin therapy. Physicians were asked to follow patients on three occasions: baseline and 4-12 weeks and 18-26 weeks, and received reminders to optimize therapy for lipid and glycemic control to achieve guideline recommended targets.

Results: Among enrolled patients 57% were male, average age was 62.7±10.5 years, and 95% had 10-year Framingham risk score of CV event ?20%; prior history of cardiovascular diagnosis was present in 20%, smoking history in 38%, blood pressure > 130/80 mmHg in 68%. At baseline, the lipid profile in mmol/L was: total cholesterol 4.88±1.04, LDL-C 2.82±0.75, HDL-C 1.25±0.45 and non HDL-C 3.63±1.07, triglycerides 1.93±1.05. Glycemic profile included fasting plasma glucose of 8.35±2.01mmo/L and A1C 7.94±0.75%. At baseline medications for dyslipidemia management were statin alone in 75% of patients and statin plus another lipid lowering therapy in 25%, and for glycemic control were metformin alone in 71% and metformin in fixed dose combination in 29%. During the follow up LDL-C declined significantly (p< 0.0001) to 2.28±0.87 (visit 2) and 2.17±0.92 (visit 3) while proportion of patients achieving LDL-C ? 2.0 mmol/L (co-primary end-point) was zero at baseline and 43% and 50% respectively during the second and third visits. The A1C declined to 7.58±1.18 and 7.53±1.30 respectively and proportion of patients achieving the A1C target (co-primary end-point) increased from zero at baseline to 35% and 43% respectively for visits two and three (p < 0.0001). With respect to blood pressure target achievement (< 130/80), it was 32% at baseline, 45% at visit 2 (4-12 weeks) and 47% at visit 3 (18-26 weeks) (p=0.0047). All three targets (BP, A1C and LDL-C) were achieved in 7% at visit 2 and 14% at visit 3.

Conclusion: The present study provides insight into the real-world application of guidelines and the need to overcome treatment inertia. It demonstrates that among patients with DM who have not yet achieved control of dysglycemia and dyslipidemia, the use of clinical reminder maybe of help in improving management.

Citation: Langer A, Tan M, Goldin L, Ngui D, Woo V (2017) Cholestabetes Medical Practice Activity (MPA): Overcoming Treatment Inertia in Diabetes. J Cardio Cardiovasu Med 2: 007.