The Analysis and Understanding of Diabetes and Dyslipidaemia: Improving Treatment (AUDIT) study was a confidential, web-based, cross-sectional survey involving 2,043 diabetes specialists in 50 countries. The study investigated the attitudes of physicians specialising in the treatment of patients with type 2 diabetes mellitus towards the management of dyslipidaemia and other cardiovascular risk factors in these patients. Physicians reported obtaining lipid profiles in 91% of patients with type 2 diabetes and estimated that 62% of type 2 diabetic patients have dyslipidaemia. Across all regions, stated low-density lipoprotein cholesterol (LDL-C), triglyceride and total cholesterol targets were lower for type 2 diabetic patients with than without cardiovascular disease (CVD). Fewer physicians reported having an LDL-C target of < 2.6 mmol/L (≤100 mg/dL) for patients without CVD (59%) than with CVD (85%). Physicians reported that 54% of patients achieve LDL-C targets, with significantly more estimated to achieve their LDL-C goal in North America (69%) than in any other region (43—61%; p<0.001). When setting targets, 58% of physicians stated that they were most influenced by lipid management guidelines, although a large proportion of physicians from Eastern Europe (54%) and Africa/Middle East (50%) cited a personal read of the literature. Patient compliance was the most commonly perceived barrier to lipid goal attainment in most regions (42—61%); financial constraints were cited most often in South America (76%), Africa/Middle East (65%) and Eastern Europe (63%). The AUDIT study revealed a disparity between lipid screening and control in type 2 diabetic patients. Physicians reported that they treated patients without CVD less intensively than patients with CVD, suggesting that type 2 diabetes was not widely considered a coronary heart disease risk equivalent. A reassessment of guideline implementation is needed for physicians worldwide to improve lipid control to decrease cardiovascular risk in type 2 diabetes.
UK Prospective Diabetes Study Group.Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet1998;352:837-53.
2.
Kleinman JC, Donahue RP, Harris MI, Finucane FF, Madans JH, Brock DBMortality among diabetics in a national sample. Am J Epidemiol1988; 128:389-401.
3.
Haffner SM, Lehto S., Ronnemaa T., Pyorala K., Laakso M.Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med1998;339:229-34.
4.
Malmberg K., Yusuf S., Gerstein HC et al. Impact of diabetes on long-term prognosis in patients with unstable angina and non-Q-wave myocardial infarction: results of the OASIS (Organization to Assess Strategies for Ischemic Syndromes) Registry. Circulation2000;102:1014-19.for
5.
Whiteley L., Padmanabhan S., Hole D., Isles C.Should Diabetes Be Considered a Coronary Heart Disease Risk Equivalent?: Results from 25 years of follow-up in the Renfrew and Paisley Survey. Diabetes Care2005;28:1588-93.
6.
Turner RC, Millns H., Neil HA et al. Risk factors for coronary artery disease in non-insulin dependent diabetes mellitus: United Kingdom Prospective Diabetes Study (UKPDS 23). BMJ1998;316:823-8.
7.
Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA2001;285:2486-97.
8.
De Backer G. , Ambrosioni E., Borch-Johnsen K. et al. European guidelines on cardiovascular disease prevention in clinical practice: third joint task force of European and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of eight societies and by invited experts) . Eur J Cardiovasc Prev Rehabil2003;10:S1-S10.
9.
American Diabetes Association.Standards of medical care in diabetes . Diabetes Care2005;28(suppl 1):S4-S36.
10.
Colhoun HM, Betteridge DJ, Durrington PN et al. Primary prevention of cardiovascular disease with atorvastatin in type 2 diabetes in the Collaborative Atorvastatin Diabetes Study (CARDS): multicentre randomised placebo-controlled trial. Lancet2004;364:685-96.
11.
Collins R., Armitage J., Parish S., Sleigh P., Peto R.MRC/BHF Heart Protection Study of cholesterol-lowering with simvastatin in 5963 people with diabetes: a randomised placebo-controlled trial. Lancet2003;361:2005-16.
12.
Sever PS, Poulter NR, Dahlof B. et al. Reduction in cardiovascular events with atorvastatin in 2,532 patients with type 2 diabetes: Anglo-Scandinavian Cardiac Outcomes Trial-Lipid-Lowering Arm (ASCOT-LLA). Diabetes Care2005;28:1151-7.
13.
Pearson TA, Laurora I., Chu H., Kafonek S.The lipid treatment assessment project (L-TAP): a multicenter survey to evaluate the percentages of dyslipidemic patients receiving lipid-lowering therapy and achieving low-density lipoprotein cholesterol goals. Arch Intern Med2000;160:459-67.
14.
Saaddine JB , Engelgau MM, Beckles GL, Gregg EW, Thompson TJ, Narayan KMA diabetes report card for the United States: quality of care in the 1990s. Ann Intern Med2002;136:565-74.
15.
Saydah SH, Fradkin J., Cowie CCPoor control of risk factors for vascular disease among adults with previously diagnosed diabetes. JAMA2004; 291:335-42.
16.
Massing MW, Foley KA, Sueta CA et al. Trends in lipid management among patients with coronary artery disease: has diabetes received the attention it deserves?Diabetes Care2003;26:991-7.
17.
Parris ES, Lawrence DB, Mohn LA, Long LBAdherence to statin therapy and LDL cholesterol goal attainment by patients with diabetes and dyslipidemia. Diabetes Care2005;28:595-9.
18.
American Diabetes Association.Dyslipidemia management in adults with diabetes. Diabetes Care2004;27(suppl 1):S68-S71.
19.
Gaede P., Vedel P., Larsen N., Jensen GV, Parving HH, Pedersen O.Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. N Engl J Med2003;348:383-93.
20.
Heart Protection StudyCollaborative Group.MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: a randomised placebo-controlled trial. Lancet2002;360:7-22.
21.
Sever PS, Dahlof B., Poulter NR et al. Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial-Lipid Lowering Arm (ASCOT-LLA): a multicentre randomised controlled trial. Lancet2003;361:1149-58.
22.
Williams B. , Poulter NR, Brown MJ et al. British Hypertension Society guidelines for hypertension management 2004 (BHS-IV): summary. BMJ2004;328:634-40.
23.
Joint British Societies.JBS2 guidelines on prevention of cardiovascular disease. Heart2005;91(suppl 1):1-51.
24.
Grundy SM, Cleeman JI, Merz CN et al. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. Circulation2004;110:227-39.
25.
LaRosa JH, LaRosa JCEnhancing drug compliance in lipid-lowering treatment. Arch Fam Med2000;9:1169-75.
26.
Kiortsis DN , Giral P., Bruckert E., Turpin G.Factors associated with low compliance with lipid-lowering drugs in hyperlipidemic patients. J Clin Pharm Ther2000;25:445-51.
27.
Hobbs FD, Erhardt L.Acceptance of guideline recommendations and perceived implementation of coronary heart disease prevention among primary care physicians in five European countries: the Reassessing European Attitudes about Cardiovascular Treatment (REACT) survey. Fam Pract2002;19:596-604.
28.
Mosca L., Linfante AH, Benjamin EJ et al. National study of physician lines. Circulation2005;111:499-510. awareness and adherence to cardiovascular disease prevention guidelines. Circulation2005;111:499-510
