Therapeutic objectives in the care of patients with diabetes mellitus type 2 in clinical practice at an endocrine department
Carmen Tenorio Jiménez1, Pablo Jose Lopez Ibarra2, Manuel Romero Muñoz2 & Maria Jimenez del Valle2
According to the American Diabetes Association (ADA), achieving specific treatment goals in type 2 diabetes can substantially reduce microvascular complications, including retinopathy, nephropathy and neuropathy. Intensive management has also been shown to have a beneficial effect on cardiovascular disease. The objective of the study is to evaluate the degree of achievement of appropriate target levels for A1C, as an index of chronic glycaemia, LDL-c and blood pressure, in a large and homogeneous sample of type 2 diabetes patients, evaluated periodically in an endocrine service. The study reviewed the clinical and biochemical data of 200 adults with type 2 diabetes, diagnosed using ADA criteria and followed by a specific diabetes unit. The primary endpoints were HBA1c ≤7%, blood pressure (BP) ≤130/80 mmHg and LDL-c ≤100 mg/dl. It was also collected measures of body mass index (kg/m2) and waist (cm) and reports about additional medical treatments: the use of statins, lowering pressure medications and insulin therapy.
The mean age of the 200 patients was 61.1±10.2 years of which 53% were female. The mean duration of diabetes was 11.7±9.4 years. 45.5% of the patients were on insulin-therapy, 56% were on statins and 62.5% were on lowering-pressure therapy. The mean body mass index (BMI) was 32.9±6.7 kg/m2; the mean waist was 109.7±12.9 cm in men and 102.40±16.5 cm in women. (Table 1: baseline characteristics). 6.83% of patients achieved their HbA1c, LDLc and BP targets; 17.17% achieved their combined HbA1c and BP targets and 24.22% their HbA1c and LDL-c goals. Target HbA1c was met by 44.7% of patients. In conclusion, a high percentage of the patients treated by the Endocrine Department achieved an optimal glycaemic control (HbA1c≤7%). However, when BP and lipids were evaluated together this percentage dropped, despite the concomitant treatment with statins and lowering-pressure therapy. Therefore, the study shows that it is essential to intensify the treatment of type 2 diabetes patients, specially that one related to BP and lipids.