w wz 16«1y Kor. J. Clin. Pharm., Vol. 16,. 1. 2006 x y x B»C s w s w w Pattern and Management of Dyslipidemia in Type 2 Diabetes Patients in Korea Kyong Ju Jeong a and Seung Ki Cho b a Dept of Pharmacy, Pundang CHA General Hospital b Department of Pharmacology, College of Medicine, Pochon CHA University, Sungnam, Kyonggi-do, 463-712, Korea Dyslipidemia is an important CHD risk factor in diabetic patients. We conducted this study to assess the pattern of dyslipidemia in type 2 diabetes patients, to examine the demographic and clinical factors associated with dyslipidemia and to evaluate attaining within the lipid target goals and treatment strategies. A retrospective analysis was conducted among patients diagnosed type 2 diabetes at outpatient clinic in endocrinology between January 2003 and December 2004. Clinical history and physical examination were reviewed and laboratory data including blood glucose, HbA1c, lipid levels were recorded sequentially at least 1 year. In 882 patients with type 2 diabetes, 437 patients (49.6%) have dyslipidemia and 73% of them (319 patients) received lipid-lowering agents. 244 patients (94 males, 150 females, mean age 60 years old) were susceptible to analyses. The most frequent pattern of dyslipidemia is high LDL level and high TG levels (28%). Metabolic syndrome and macrovascular complication were significant negative independent association with lipid levels within the target goals (p<0.05). Only 15.2% (19 males, 18 females) attained within the lipid target goals. Patients with diabetic dyslipidemia need maximization of lipid-lowering agent, increasing the fibric acid derivatives prescription and the effort to correction of low HDL and/or high TG. Key words Dyslipidemia, Type 2 diabetes, Pattern of dyslipidemia, Lipid target goal w w y yƒ w ƒ y y š y jš. 2003 w x y w ƒƒ 3 4 wš p w ù 10 2 ƒ. x y 1) w 2.5-4 ƒ j š2,3) y 50-80% y ƒ x» š x š. 2x y y 4-6) wù, x y š, total cholesterol( w TC) LDL-cholesterol( w LDL-C) ƒ û HDLcholesterol( w HDL-C) triglyceride( w TG) ƒ Correspondence to :» s w w» û k 351 Tel: 031-780-5740, Fax: 031-780-5741 E-mail: ddoldolikr@yahoo.co.kr y ƒ k. 2x y 4-7) x s w x y x ü š 4-6), 2x š v e ge w TGƒ ûš HDL-C û w LDL-C HDL-Cƒ š š š. 8,9) m w 2x y ùkü y p w š y x s w š w. w y x p t x (lipid target goal) sƒw y ww e z w š w. 2003 1 2004 12 ¾ ü ü y 2x y 46
2x y x 47 882» zw w, n», w, šx y, d, x e(, š x,» ) 1 w. 882 y 437 x e 1z x ùkü š( y 49.6%, s³ 59.8, 60.9% ) 319 ( y 73%) w n. w n 2x y 1z x x e z (follow-up)ƒ y 244 š y l wš m w. e t x x te xz w y» œ x 80-120 mg/dl, HbA1c 7%, LDL- C 100 mg/dl, HDL-C û 45 mg/dl, 55 mg/dl, TG 150 mg/dl w. 10) œ y w z (Metabolic syndrome)» NCEP ATPIII(US National Cholesterol Education Program: Adult Treatment Panel III) (x ƒ û 35 e, 31 e ), TGƒ 150 mg/dl, HDL-C û 40 mg/dl, 50 mg/dl, x» 130 mmhg» 85 mmhg, œ x 110 mg/dl e 5 w 3 w z w. x w» (neuropathy), (nephropathy), (retinopathy) ù w š w. x w» y(coronary artery disease), x y(cerebrovascular disease), y (peripheral arterial disease) ù» y š w š w. šx» x w w šx w. SPSS 12.0K l w, 95% w š, x te y p» w p z (logistic regression analysis) w. y p w n 2x y 1z x x e z ƒ w ƒ w y 244 š û 94, 150. s³ 60, s³ (body mass index, w BMI) 25.2kg/m 2, s³» 10.4, s³ HbA1c 8.32% x ƒ š. w y 70.9% z ƒ š š, x w 27.5%, x w 52.9% ƒ š (Table 1). ƒ x w sulfonylurea biguanide ƒƒ 31% wš. x s w x x x LDL-C TGƒ xkƒ 28% ƒ w š, LDL-C xk 19% ùkü ƒ w statin 77% y. y» x x 70% LDL-Cƒ t ùkü š, û 30%, 51% HDL-Cƒ t, 74% y TGƒ t e ùkü. x e z cholesterol e» e ùkû (paired t-test, p ). Table 1. Demographics and clinical characteristics All (n=244) Male (n=94) Female (n=150) Age, years a Duration of diabetes, years a BMI, kg/m 2 a HbA1c, % a Metabolic syndrome, % b Macrovascular complication, % b Microvascular complication, % b (*= p ) a Values are mean(ûsd) b Values are percentages(95% CI) 60.2(±11.3) 10.4(±5.8) 25.2(±6.8) 8.3(±1.4) 70.9(65.2-76.6) 27.5(21.8-33.1) 52.9(46.6-59.1) 56.7(±11.6)* 9.47(±5.3)* 24.8(±2.5) 8.2(±1.5) 66.6(57.1-76.1) 24.5(15.8-33.2) 42.6(32.6-52.6) 62.5(±10.6)* 11.0(±6.1)* 25.6(±8.5) 8.4(±1.4) 73.3(66.2-80.4) 29.3(22.0-36.6) 59.3(51.4-67.1)
48 Kor. J. Clin. Pharm., Vol. 16,. 1, 2006 x y,,», BMI, z, HbA1c, šx w ƒ x x» n z w.» r, HbA1cƒ LDL-Cƒ y ƒ š, BMIƒ 25 w y TG HDL-Cƒ t e ù. z y y w LDL-C, TG, HDL-C ƒ w. û HDL-C» e w y ƒ w (Table 2). n z(follow-up) x e» w ù, z 2x y TG, HDL-C, HDL-C wy, šx y HDL-C wy ƒ w (Table 3). tx y xz «š» x t LDL, HDL-C, TG ƒ w y 37 15.2%(û 20.2%, 12%) w.» w wƒ ƒ te w w y 26.6 % ƒ y ƒ te ù w HDL-C. w te w w y 42.6% ƒ y ƒ te ù w TG HDL-C. w ƒ w te w w y 15.6%(û 8.5%, 20%) ùkû (Fig. 1, Table 4). e w e û w ù ùkû (p= 0.023)(Fig 2, Table 4). œ y w x w w y 176 (72%) š, Table 2. Prevalence of dyslipidemia in initial lab data according to selected demographic and clinical variables. Values are percentage of patients Gender Male Female Age, years < 50 50-69 70 Duration of DM, years 5 6-10 > 10 HbA1c, % < 7 7-8 > 8 BMI 25 > 25 Metabolic syndrome Hypertension a Fisher s exact test b Chi-square test Patients, n 94 150 44 149 51 64 146 81 126 102 136 71 173 176 68 LDL initial ( 130 mg/dl) 70.2 70 68.2 65.8 84.3 65.2 75.6 67.6 64.2 77.8 71.9 67.3 87.3 63 66.2 71.6 TG initial ( 150 mg/dl) 75.5 72.0 81.8 73.8 64.7 82.6 66.7 75.0 83.8 69.1 73.0 68.5 80.6 36.6 88.4 64.7 76.7 HDL initial ( 45 mg/dl men, 55 mg/dl women) 41.5 67.3 52.3 57.7 60.8 63.0 44.4 65.7 59.5 59.3 55.6 50.0 68.4 21.1 72.3 48.5 60.8
2x y x 49 Table 3. Prevalence of dyslipidemia in follow up lab data according to selected demographic and clinical variables. Values are percentage of patients Gender Male Female Age, years < 50 50-69 70 Duration of DM, years 5 6-10 > 10 HbA1c, % < 7 7-8 > 8 BMI 25 > 25 Metabolic syndrome Hypertension a Fisher s exact test b Chi-square test Patients, n 94 150 44 149 51 64 146 81 126 102 136 71 173 176 68 LDL cholesterol ( 130 mg/dl) 51.1 54.0 51.7 52.9 43.5 61.6 50.0 50.6 53.2 52.1 54.1 60.6 49.7 60.3 50.0 TG ( 150 mg/dl) 54.3 52.7 55.0 45.1 60.9 47.8 54.6 51.4 51.9 54.8 48.6 60.2 29.6 63.0 44.1 HDL cholesterol ( 45mg/dl men, 55mg/dl women) 57.4 72.0 63.6 66.4 68.6 65.2 58.9 73.1 59.5 65.4 69.0 61.6 73.5 39.4 77.5 54.4 71.0 Fig 2. Sex disparity in the outside of lipid target goals. Fig 1. Percentage of patients with none, one, two, three lipid values outside of the recommended clinical target. z ƒ š y 173 (70.9%), x w y ƒ š y 37 (15%), x y ƒ š y 33 (13.5%). x w ƒ š y 109 (44.7%), 33 (13.5%), (13.9%).
50 Kor. J. Clin. Pharm., Vol. 16,. 1, 2006 Table 4. Percentages of patients (total = 244) with none, one, two, three lipid values outside of the recommended clinical target established by the American Diabetes Association Patients (n=244) n (%) n out of target 37 (15.2) One out of target LDL TG HDL Two out of target LDL + TG LDL + HDL TG + HDL Three out of target 65 (26.6) 20 (8.2) 12 (4.9) 33 (13.5) 104 (42.6) 33 (13.5) 27 (11.1) 44 (18.0) 38 (15.6) tx n z t x w, BMI,»w, HbA1c, z, x w, x w w pz (logistic regression analysis) w., z x w t x w w ùkû (p=0.05). š Male (n=94) n (%) 19 (20.2) 28 (29.8) 10 (10.6) 8 (8.5) 10 (10.6) 39 (41.5) 16 (17.0) 8 (8.5) 15 (16.0) 8 (8.5) Female (n=150) n (%) 18 (12.0) 37 (24.7) 10 (6.7) 4 (2.7) 23 (15.3) 65 (43.3) 17 (11.3) 19 (12.7) 29 (19.3) 30 (20.0) y s³ HbA1c 8.32% š w x. wz «š 7% û x w e ƒ v w. wz «š HbA1c 1% û w x (relative risk) 15-30% w š šwš. 10) x ù. 4,6,11) y k w x ƒ. y ƒ û w w ù ƒ š» ¼» x t x û w û š (p=0.023). û w š e û w. k y û y w x w n w ùkü š š wš. 71%ƒ z ƒ š 12) š, w, x e ƒ, x 13) z» y x w ƒ š. 14) x e ƒ xz «š 10) National Cholesterol Education 15) Program(NCEP) Adult Treatment Panel III guideline» wš. ww e «š w txx(metabolic phenotype), z ƒ š x sw w w y y wì ww w. w 16) 70% y LDL-C ƒ š y LDL-C y w š w y w ùkü šƒ š, 80% 17) w y ƒ x š(major vascular event)ƒ w ù w w šƒ. 17,18) 2x y e ƒ t x x w. šx e,, aspirin n, š w n sw. ù w n 19) t x r y 15.2%(û 20.2%, 12%) k 4) ƒ û. û t x w e w š w w š. w ƒ HMG-CoA reductase inhibitor( w statins) 77% y n š ù n z eš. ƒ ³ 20) LDL-C w w statins n ƒw x ƒ w ¾ n w v ƒ. w x 22% š 17) fibrates. Fibrates y š x z HDL-C ƒ j z. Fibrate n w TG 16,21) 50% ¾ š HDL-C 10% ü ƒ ùkü. 22,23) Fibrates HDL, LDL-Cƒ û y statins z šƒ 24) LDL-Cƒ 100 mg/dl HDL-Cƒ û statins gemfibrozil n w š w. 17) w ƒ wš n - w ƒ v w. w y w ƒ 2x y x tw š w»» y ³ ƒ v w š. y e ƒ wš y t e w»¾ ƒ v w y y
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