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The impact of outpatient diabetes management on serum lipids in urban African-Americans with type 2 diabetes.
Diabetes Care. 2002 Jan; 25(1):9-15.DC

Abstract

OBJECTIVE

Treating dyslipidemia in diabetic patients is essential, particularly among minority populations with increased risk of complications. Because little is known about the impact of outpatient diabetes management on lipid outcomes, we examined changes in lipid profiles in urban African-Americans who attended a structured diabetes care program.

RESEARCH DESIGN AND METHODS

A retrospective analysis of initial and 1-year follow-up lipid values was conducted among patients selected from a computerized registry of an urban outpatient diabetes clinic. The independent effects of lipid-specific medications, glycemic control, and weight loss on serum total cholesterol, LDL cholesterol, HDL cholesterol, and triglyceride levels were evaluated by analysis of covariance and multiple linear regression.

RESULTS

In 345 patients (91% African-American and 95% with type 2 diabetes), HbA(1c) decreased from 9.3% at the initial visit to 8.2% at 1 year (P < 0.001); total and LDL cholesterol and triglyceride levels were significantly lower, and HDL cholesterol was higher. After stratifying based on use of lipid-specific therapy, different outcomes were observed. In 243 patients not taking dyslipidemia medications, average total cholesterol, LDL cholesterol, and triglyceride concentrations at 1 year were similar to initial values, whereas in 102 patients receiving pharmacotherapy, these lipid levels were all lower at 1 year relative to baseline (P < 0.001). Mean HDL cholesterol increased regardless of lipid treatment status (P < 0.001). After adjusting for other variables, changes in LDL cholesterol concentration were associated only with use of lipid-specific agents (P = 0.003), whereas improved HbA(1c) and weight loss had no independent effect. Lipid therapy, improved glycemic control, and weight loss were not independently related to changes in HDL cholesterol and therefore could not account for the positive changes observed. Use of lipid-directed medications, improvement in glycemic control, and weight loss all resulted in significant declines in triglyceride levels but only improved HbA(1c) and weight loss had an independent effect.

CONCLUSIONS

Among urban African-Americans, diabetes management led to favorable changes in HDL cholesterol and triglyceride levels, but improved glycemic control and weight loss had no independent effect on LDL cholesterol concentration. Initiation of pharmacologic therapy to treat high LDL cholesterol levels should be considered early in the course of diabetes management to reach recommended targets and reduce the risk of cardiovascular complications in this patient population.

Authors+Show Affiliations

Grady Health System Atlanta, Emory University School of Medicine, Atlanta, Georgia 30303, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

11772894

Citation

Erdman, Diane M., et al. "The Impact of Outpatient Diabetes Management On Serum Lipids in Urban African-Americans With Type 2 Diabetes." Diabetes Care, vol. 25, no. 1, 2002, pp. 9-15.
Erdman DM, Cook CB, Greenlund KJ, et al. The impact of outpatient diabetes management on serum lipids in urban African-Americans with type 2 diabetes. Diabetes Care. 2002;25(1):9-15.
Erdman, D. M., Cook, C. B., Greenlund, K. J., Giles, W. H., El-Kebbi, I., Ryan, G. J., Gallina, D. L., Ziemer, D. C., Dunbar, V. G., & Phillips, L. S. (2002). The impact of outpatient diabetes management on serum lipids in urban African-Americans with type 2 diabetes. Diabetes Care, 25(1), 9-15.
Erdman DM, et al. The Impact of Outpatient Diabetes Management On Serum Lipids in Urban African-Americans With Type 2 Diabetes. Diabetes Care. 2002;25(1):9-15. PubMed PMID: 11772894.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The impact of outpatient diabetes management on serum lipids in urban African-Americans with type 2 diabetes. AU - Erdman,Diane M, AU - Cook,Curtiss B, AU - Greenlund,Kurt J, AU - Giles,Wayne H, AU - El-Kebbi,Imad, AU - Ryan,Gina J, AU - Gallina,Daniel L, AU - Ziemer,David C, AU - Dunbar,Virginia G, AU - Phillips,Lawrence S, PY - 2002/1/5/pubmed PY - 2002/3/20/medline PY - 2002/1/5/entrez SP - 9 EP - 15 JF - Diabetes care JO - Diabetes Care VL - 25 IS - 1 N2 - OBJECTIVE: Treating dyslipidemia in diabetic patients is essential, particularly among minority populations with increased risk of complications. Because little is known about the impact of outpatient diabetes management on lipid outcomes, we examined changes in lipid profiles in urban African-Americans who attended a structured diabetes care program. RESEARCH DESIGN AND METHODS: A retrospective analysis of initial and 1-year follow-up lipid values was conducted among patients selected from a computerized registry of an urban outpatient diabetes clinic. The independent effects of lipid-specific medications, glycemic control, and weight loss on serum total cholesterol, LDL cholesterol, HDL cholesterol, and triglyceride levels were evaluated by analysis of covariance and multiple linear regression. RESULTS: In 345 patients (91% African-American and 95% with type 2 diabetes), HbA(1c) decreased from 9.3% at the initial visit to 8.2% at 1 year (P < 0.001); total and LDL cholesterol and triglyceride levels were significantly lower, and HDL cholesterol was higher. After stratifying based on use of lipid-specific therapy, different outcomes were observed. In 243 patients not taking dyslipidemia medications, average total cholesterol, LDL cholesterol, and triglyceride concentrations at 1 year were similar to initial values, whereas in 102 patients receiving pharmacotherapy, these lipid levels were all lower at 1 year relative to baseline (P < 0.001). Mean HDL cholesterol increased regardless of lipid treatment status (P < 0.001). After adjusting for other variables, changes in LDL cholesterol concentration were associated only with use of lipid-specific agents (P = 0.003), whereas improved HbA(1c) and weight loss had no independent effect. Lipid therapy, improved glycemic control, and weight loss were not independently related to changes in HDL cholesterol and therefore could not account for the positive changes observed. Use of lipid-directed medications, improvement in glycemic control, and weight loss all resulted in significant declines in triglyceride levels but only improved HbA(1c) and weight loss had an independent effect. CONCLUSIONS: Among urban African-Americans, diabetes management led to favorable changes in HDL cholesterol and triglyceride levels, but improved glycemic control and weight loss had no independent effect on LDL cholesterol concentration. Initiation of pharmacologic therapy to treat high LDL cholesterol levels should be considered early in the course of diabetes management to reach recommended targets and reduce the risk of cardiovascular complications in this patient population. SN - 0149-5992 UR - https://www.unboundmedicine.com/medline/citation/11772894/The_impact_of_outpatient_diabetes_management_on_serum_lipids_in_urban_African_Americans_with_type_2_diabetes_ L2 - http://care.diabetesjournals.org/cgi/pmidlookup?view=long&amp;pmid=11772894 DB - PRIME DP - Unbound Medicine ER -