An Audit of Lipid Management in Patients with Diabetes in an Academic Internal Medicine Practice

Abstract

Background:

There is increasing pressure from health insurers that clinicians meet nationally accepted standards of care for patients with diabetes. How quality improvement initiatives will be implemented in the ambulatory care setting remains unclear.

Objective:

To conduct an audit of lipoprotein management in patients with diabetes in a single academic internal medicine practice, using low-density lipoprotein cholesterol (LDL-C) as the primary measurement, and compare results to nationally reported data.

Methods:

A retrospective, cross-sectional study involving all patients with diabetes seen in an internal medicine faculty practice from January 1, 2004, to December 31, 2004, was performed. Data collected included results of lipid tests performed within the past year, medications to lower cholesterol, and markers of diabetes control.

Results:

Two hundred eight patients with diabetes were eligible for the study. Forty-two percent were at the LDL-C goal of less than 100 mg/dL. Sixty-five percent were taking a hydroxymethylglutaryl coenzyme A reductase inhibitor (statin), while 6.6% were taking 2 or more lipid-lowering drugs. Twenty-four patients (12%) had high LDL-C levels (>130 mg/dL) but were not taking lipid-lowering agents; these patients were older compared with the population with an LDL-C level at the goal (mean ± SD 66 ± 15 vs 59 ± 15 y; p < 0.05) and less likely to have coronary artery disease (8.7% vs 33%; p < 0.05). Thirty-six percent of patients were above the goal LDL-C despite use of statins at moderate or higher doses.

Conclusions:

Achieving goal LDL-C levels remains a challenge, even in this era of powerful, proven pharmacotherapy. Strategies to improve lipid management may need to address issues of patient acceptance of and adherence to cholesterol-lowering drug therapy. Audits are helpful to compare practice data with accepted benchmarks, but confounders must be considered if the audit data are used for high-stakes decisions.