한 병원의 사례로 본 당뇨 환자의 이상지질혈증 관리현황 평가
Evaluation on Management of Dyslipidemia in Diabetic Patients
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It is important to manage dyslipidemia intensively to prevent the cardiovascular disease known as the leading cause of mortality in diabetic patients. The small-dense LDL cholesterol, which is the major risk factor for atherosclerosis, is suggested as the primary target for lipid lowering management in type 2 diabetic patients. The Korean Diabetes Association suggests that lipid assessments should be performed annually after the diagnosis of diabetes. In this study, we analyzed the lipid profiles to examine if the diabetic patients with dyslipidemia were treated with lipid-lowering drugs and to ascertain whether they were achieving NCEP LDL target levels. The subjects of the study were 318 patients with type 2 diabetes mellitus whose lipid profiles were evaluable through medical records, treated in our hospital from January to December in 2008. We set up the baseline as the first lipid test results during the period of the study and the final outcome as lipid test results measured after the follow-up period. We evaluated the lipid profiles and classify them into three groups: The first group had LDL cholesterol below 100mg/dL which is specified as the cut-point of the NCEP ATP Ⅲ (National Cholesterol Education Program Adult Treatment Panel Ⅲ) guideline. The second group had LDL cholesterol level of 100-129mg/dL at which to start lifestyle change, and the last group had upper 130mg/dL at which to consider drug therapy. As the result, 187 patients(58.8%) had their LDL-cholesterol level below 100mg/dL while 131 patients(41.2%) had the level over 100mg/dL in the baseline. After the follow-up period, 72.6% of all the subjects(318 patients) achieved the target level, under 100mg/dL, but 27.4% of them could not meet the goal. 197 patients(62%) were prescribed lipid-lowering drugs while 121 patients(38%) were not. Among the group of patients without lipid-lowering drugs, 11 patients(24.4%) were needed to be treated with the drugs since they had LDL-cholesterol level over 130mg/dL. The study showed that whether to prescribe lipid-lowering drugs derived a significant difference in lipid profiles between the baseline levels and those after follow-up period. Use of rosuvastatin and simvastatin showed a significant difference in LDL-cholesterol level after follow-up period. Among the patients who were prescribed the drugs(197 patients), 40.2% of them with the LDLcholesterol level over 100mg/dL in the baseline were decreased to 27.4% as the result of postfollow-up. We found out that appropriate medication use following the established treatment guideline and management of patients’compliance are necessary to control dyslipidemia in diabetic patients.
Abstract
It is important to manage dyslipidemia intensively to prevent the cardiovascular disease known as the leading cause of mortality in diabetic patients. The small-dense LDL cholesterol, which is the major risk factor for atherosclerosis, is suggested as the primary target for lipid lowering management in type 2 diabetic patients. The Korean Diabetes Association suggests that lipid assessments should be performed annually after the diagnosis of diabetes. In this study, we analyzed the lipid profiles to examine if the diabetic patients with dyslipidemia were treated with lipid-lowering drugs and to ascertain whether they were achieving NCEP LDL target levels. The subjects of the study were 318 patients with type 2 diabetes mellitus whose lipid profiles were evaluable through medical records, treated in our hospital from January to December in 2008. We set up the baseline as the first lipid test results during the period of the study and the final outcome as lipid test results measured after the follow-up period. We evaluated the lipid profiles and classify them into three groups: The first group had LDL cholesterol below 100mg/dL which is specified as the cut-point of the NCEP ATP Ⅲ (National Cholesterol Education Program Adult Treatment Panel Ⅲ) guideline. The second group had LDL cholesterol level of 100-129mg/dL at which to start lifestyle change, and the last group had upper 130mg/dL at which to consider drug therapy. As the result, 187 patients(58.8%) had their LDL-cholesterol level below 100mg/dL while 131 patients(41.2%) had the level over 100mg/dL in the baseline. After the follow-up period, 72.6% of all the subjects(318 patients) achieved the target level, under 100mg/dL, but 27.4% of them could not meet the goal. 197 patients(62%) were prescribed lipid-lowering drugs while 121 patients(38%) were not. Among the group of patients without lipid-lowering drugs, 11 patients(24.4%) were needed to be treated with the drugs since they had LDL-cholesterol level over 130mg/dL. The study showed that whether to prescribe lipid-lowering drugs derived a significant difference in lipid profiles between the baseline levels and those after follow-up period. Use of rosuvastatin and simvastatin showed a significant difference in LDL-cholesterol level after follow-up period. Among the patients who were prescribed the drugs(197 patients), 40.2% of them with the LDLcholesterol level over 100mg/dL in the baseline were decreased to 27.4% as the result of postfollow-up. We found out that appropriate medication use following the established treatment guideline and management of patients’compliance are necessary to control dyslipidemia in diabetic patients.
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