The State of Lipid Control in Patients with Diabetes in a Public Health Care Centre

Abstract

Achieving treatment targets has been difficult in treating diabetic patients. This cross-sectional study describes the lipid profiles of patients with diabetes mellitus at a public primary health care centre in Sarawak, Malaysia. The targets for lipid control were based on the International Diabetes Federation recommendation (2002). 1031 patients (98% Type 2 Diabetes) were studied. Fasting lipid profiles were available in 990 (96%) patients. The mean total cholesterol was 5.3 +/- 1.0 mmol/L, Triglycerides 1.90 +/- 1.26 mmol/L, HDL-C 1.28 +/- 0.33 mmol/L and LDL-C 3.2 +/- 0.9 mmol/L. Overall, 22% of patients achieved the treatment target for LDL-C level < 2.6mmol/L. 67% of patients had HDL-C > 1.1 mmol/L and 42% of patients had a target TG level below 1.5 mmol/L. Of the 40% of patients who received lipid-lowering drug, 17% achieved LDL-C target, 50% had LDL-C 2.6-4.4 mmol/ L and 33% have LDL-C > 4.0 mmol/L. For the remaining 60% not receiving any lipid lowering therapy, 68% had LDL-C between 2.6-4.0 mmol/L and 7% had LDL-C level > 4 mmol/L. Dyslipidemia is still under-treated despite the availability of effective pharmacological agents and the greatly increased risk of cardiovascular diseases in diabetic patients.

Study protocol of EMPOWER Participatory Action Research (EMPOWER-PAR): a pragmatic cluster randomised controlled trial of multifaceted chronic disease management strategies to improve diabetes and hypertension outcomes in primary care

“…Similarly, a study looking at the process of care and the choice of antihypertensive medications in public and private primary care clinics in Malaysia revealed that 21% of prescription practices were less than optimal in both sectors [13]. A lipid control study of diabetics revealed that the target low density lipoprotein cholesterol (LDL-C) of ≤ 2.6 mmol/L was achieved in only 22% of diabetic patients attending a public primary care clinic in Sarawak, Malaysia [14]. …”

Angiographic biomarkers are significant predictors of treatment response to intravitreal aflibercept in diabetic macular edema

“…Patients with high LDL levels ≥ 2.6 mmol/L (100 mg/dL) experienced greater improvements in BCVA ( p = 0.017, c = 1.90 ETDRS letters). The level of 2.6 mmol/l was chosen as the cut off value as population studies have shown that the LDL range in DM patients should optimally be below 2.6 mmol/L 22 . Patients above and below this 2.6 mmol/L cut off both demonstrated an improvement in BCVA at 6 months but those in the higher LDL group demonstrated greater improvements.…”

The Primary Health Care Performance Initiative (PHCPI): Issues and Challenges for Malaysia as a Trailblazer Country

“…Similarly, a study looking at the process of care and the choice of antihypertensive medications in public and private Primary Care Clinics in Malaysia revealed that 21% of prescription practices were less than optimal in both sectors [42]. A lipid control study of patients with diabetes revealed that the target low density lipoprotein cholesterol (LDL-C) of ≤ 2.6 mmol/L was achieved in only 22% of patients attending a public Primary Care clinic in Sarawak [43]. Suboptimal management of chronic conditions in Primary Care lead to the massive burden of treating complications in secondary care [28,44], as well as burdening patients and their families due to morbidity and premature deaths, and burdening the country due to the premature loss of human capital [44][45][46].…”