KMID : 1200020220460030464
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Diabetes & Metabolism Journal 2022 Volume.46 No. 3 p.464 ~ p.475
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Current Status of Low-Density Lipoprotein Cholesterol Target Achievement in Patients with Type 2 Diabetes Mellitus in Korea Compared with Recent Guidelines
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Yun Soo-Jin
Jeong In-Kyung Cha Jin-Hye Lee June-Young Cho Ho-Chan Choi Sung-Hee Chun Sung-Wan Jeon Hyun-Jeong Kang Ho-Cheol Kim Sang-Soo Ko Seung-Hyun Koh Gwan-Pyo Kwon Su-Kyoung Lee Jae-Hyuk Moon Min-Kyong Noh Jung-Hyun Park Cheol-Young Kim Sung-Rae
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Abstract
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Background: We evaluated the achievement of low-density lipoprotein cholesterol (LDL-C) targets in patients with type 2 diabetes mellitus (T2DM) according to up-to-date Korean Diabetes Association (KDA), European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS), and American Diabetes Association (ADA) guidelines.
Methods: This retrospective cohort study collected electronic medical record data from patients with T2DM (¡Ã20 years) managed by endocrinologists from 15 hospitals in Korea (January to December 2019). Patients were categorized according to guidelines to assess LDL-C target achievement. KDA (2019): Very High-I (atherosclerotic cardiovascular disease [ASCVD]) <70 mg/dL; Very High-II (target organ damage [TOD], or cardiovascular risk factors [CVRFs]) <70 mg/dL; high (others) <100 mg/dL. ESC/EAS (2019): Very High-I (ASCVD): <55 mg/dL; Very High-II (TOD or ¡Ã3-CVRF) <55 mg/dL; high (diabetes ¡Ã10 years without TOD plus any CVRF) <70 mg/dL; moderate (diabetes <10 years without CVRF) <100 mg/dL. ADA (2019): Very High-I (ASCVD); Very High-II (age ¡Ã40+ TOD, or any CVRF), for high intensity statin or statin combined with ezetimibe.
Results: Among 2,000 T2DM patients (mean age 62.6 years; male 55.9%; mean glycosylated hemoglobin 7.2%) ASCVD prevalence was 24.7%. Of 1,455 (72.8%) patients treated with statins, 73.9% received monotherapy. According to KDA guidelines, LDL-C target achievement rates were 55.2% in Very High-I and 34.9% in Very High-II patients. With ESC/EAS guidelines, target attainment rates were 26.6% in Very High-I, 15.7% in Very High-II, and 25.9% in high risk patients. Based on ADA guidelines, most patients (78.9%) were very-high risk; however, only 15.5% received high-intensity statin or combination therapy.
Conclusion: According to current dyslipidemia management guidelines, LDL-C goal achievement remains suboptimal in Korean patients with T2DM.
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KEYWORD
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Cholesterol, LDL, Diabetes mellitus, type 2, Dyslipidemias, Guideline, Hydroxymethylglutaryl-CoA reductase inhibitors
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