Key result
Uncontrolled cardiometabolic risk factors fail to prompt treatment intensification in up to ~71% of patients.
Why the study?
Undertreatment of blood pressure, lipid, and glycemic risk factors in patients with type 2 diabetes is common, but the influence of elevated risk factor levels on treatment changes is unclear.
Cohort (n=3,029)
Substantial undertreatment of risk factors persists in type 2 diabetes; leaves open effective strategies to enhance primary care intensification.
Undertreatment of risk factors in patients with type 2 diabetes is common. We assessed the influence of elevated levels of blood pressure, total cholesterol, and A1C on decisions of Dutch general practitioners to change drug treatment in a cohort of 3,029 patients during a 1-year period. Respectively, 58, 71, and 21% of patients remained untreated despite poor blood pressure, lipid levels, and glycemic control. Of poorly controlled but already drug-treated patients, 52% did not receive intensification for antihypertensive medication, 81% not for lipid-lowering medication, and 43% not for glucose-lowering medication. We observed a significantly lower treatment intervention rate in moderately than in poorly controlled patients for blood pressure. This was not seen for decisions on cholesterol or A1C results. The low overall action rates observed for blood pressure and especially lipid management cannot sufficiently be explained by the use of treatment thresholds higher than those indicated by guidelines.
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Voorham et al. (2008) conducted a cohort in Type 2 diabetes (n=3,029). Elevated levels of blood pressure, total cholesterol, and A1C vs. Moderately controlled risk factor levels was evaluated on Decisions of general practitioners to change drug treatment. Elevated cardiometabolic risk factors often did not prompt treatment changes, with 58%, 71%, and 21% of patients remaining untreated despite poor blood pressure, lipids, and A1C.
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