Arch Hellen Med, 27(2), March-April 2010, 215-221
Metabolic control of patients with diabetes mellitus in the primary care setting
Α. GIKAS,1 Ν. ΤSAKOUNTAKIS,2 D. ΜICHALIS,3 Α. SOTIROPOULOS,4,5
OBJECTIVE To examine the goal attainment rates for patients with diabetes mellitus with respect to glycemic, lipid and blood pressure control.
METHOD Data were abstracted from the medical records of patients with diabetes mellitus who visited 4 primary care units during the year 2007-2008. In total, 673 diabetic subjects (353 women and 320 men) were recruited, of whom 99% were suffering from type 2 diabetes and had the following characteristics: mean age 66±9 years, duration of disease 9±8 years, BMI 31±5 kg/m2.
RESULTS The mean value of HbA1c was 7.1±1.2%. Glycemic control was optimal (HbA1c <7%) in 52%, fair (HbA1c=7-7.9%) in 31% and poor (HbA1c >=8%) in 17% of the diabetic patients. The mean value of the systolic blood pressure was 138±15 mmHg and the diastolic 79±9 mmHg; the therapeutic goal of <130/80 mmHg was achieved by 24% of the study population. Concerning lipid levels, 38% of the patients were at goal (<100 mg/dL) for LDL cholesterol (LDL-C), 61% had total cholesterol <200 mg/dL, 62% had triglycerides <150 mg/dL and 64% had HDL cholesterol at recommended levels (>40 mg/dL in men, >50 mg/ dL in women). Only 7% of the diabetic patients achieved the combined goals for HbA1c, LDL-C and blood pressure. Multivariate analysis showed that obesity, duration of diabetes and place of residency were strongly related to goal attainment.
CONCLUSIONS The quality of glycemic, lipid and especially blood pressure management is suboptimal in a significant proportion of primary care patients with type 2 diabetes. More efficient intervention is needed in order to improve the care of these patients.
Key words: Blood pressure control, Diabetes mellitus, Glycemic control, Lipid control, Primary care.