RISK MODIFICATION FOR DIABETIC PATIENTS ARE OTHER RISK FACTORS TREATED AS DILIGENTLY AS GLYCEMIA?

Main Article Content

Baiju R. Shah
Muhammad Mamdani
Liisa Jaakkimainen
Janet E. Hux

Keywords

diabetes mellitus, risk modification, drug prescriptions, administrative data

Abstract

Background


The importance of glucose control is recognized both by patients with diabetes and their physicians. However, other preventative interventions, such as using medications to manage lipid and blood pressure levels, are underused for diabetic patients.


 


Objectives


To determine whether patients with diligent glucose management are more likely to use medications that treat lipids and blood pressure.


 


Methods


Administrative data records were evaluated for all diabetic patients aged 65 or older residing in Ontario in


1999 without pre-existing coronary artery disease (n=161,553). Measures of diligent glucose management were insulin use and frequent capillary glucose testing (? 2 per day). Outcomes were prescription of a lipid-lowering drug or antihypertensive drug. Using multivariate modeling, odds ratios for each diligence measure were determined for each outcome, adjusting for age, sex, comorbidities, and other covariates.


 


Results


Patients using insulin did not have a clinically important difference in lipid-lowering drug use (adjusted odds ratio 0.9, 99% confidence interval 0.9–1.0, P=0.002) or antihypertensive drug use (adjusted odds ratio 1.1, 99% confidence interval 1.0–1.1, P<0.001) versus non-users. Adjusted odds ratios for frequent glucose testing were not significantly different from unity for either lipid-lowering or antihypertensive drug use.


 


Conclusions


Patients who required and were capable of diligent glucose management, which is invasive, expensive and  time-consuming, were  no  more  likely  to  use  medications to  control  lipids  or  blood  pressure. Preventative care for patients with diabetes may be too focused on glycemic control, and may  be neglecting the management of other cardiovascular risk factors.

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