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AUDIT study. Evidence of global undertreatment of dyslipidaemia in patients with type 2 diabetes mellitus

Division of Endocrinology & Metabolism, St Michael's Hospital, University of Toronto, Ontario, Canada, leiterl{at}smh.toronto.on.ca

D John Betteridge

Royal Free & University College Medical School, London, UK

Antonio R Chacra

Department of Internal Medicine-Endocrinology, Federal University of São Paulo, Brazil. RE

Alan Chait

Division of Metabolism, Endocrinology & Nutrition, University of Washington, Seattle, Washington, USA

Eleuterio Ferrannini

Department of Internal Medicine, CNR Institute of Clinical Physiology, University of Pisa School of Medicine, Italy

Steven M Haffner

Department of Medicine, University of Texas Health Science Center, San Antonio, Texas, USA

Takashi Kadowaki

Department of Metabolic Diseases, Graduate School of Medicine, University of Tokyo, Japan

Jaakko Tuomilehto

Department of Epidemiology and Health Promotion, National Public Health Institute, Helsinki, Finland

Paul Zimmet

International Diabetes Institute, Caulfield, Australia

Connie B Newman

Pfizer Inc., New York, USA

Judith Hey-Hadavi

Pfizer Inc., New York, USA

Caroline Walkinshaw

Pfizer Inc., New York, USA

On Behalf Of The Audit Study Steering Committee

The Analysis and Understanding of Diabetes and Dyslipidaemia: Improving Treatment (AUDIT) study was a confidential, web-based, cross-sectional survey involving 2,043 diabetes specialists in 50 countries. The study investigated the attitudes of physicians specialising in the treatment of patients with type 2 diabetes mellitus towards the management of dyslipidaemia and other cardiovascular risk factors in these patients. Physicians reported obtaining lipid profiles in 91% of patients with type 2 diabetes and estimated that 62% of type 2 diabetic patients have dyslipidaemia. Across all regions, stated low-density lipoprotein cholesterol (LDL-C), triglyceride and total cholesterol targets were lower for type 2 diabetic patients with than without cardiovascular disease (CVD). Fewer physicians reported having an LDL-C target of < 2.6 mmol/L (100 mg/dL) for patients without CVD (59%) than with CVD (85%). Physicians reported that 54% of patients achieve LDL-C targets, with significantly more estimated to achieve their LDL-C goal in North America (69%) than in any other region (43—61%; p<0.001). When setting targets, 58% of physicians stated that they were most influenced by lipid management guidelines, although a large proportion of physicians from Eastern Europe (54%) and Africa/Middle East (50%) cited a personal read of the literature. Patient compliance was the most commonly perceived barrier to lipid goal attainment in most regions (42—61%); financial constraints were cited most often in South America (76%), Africa/Middle East (65%) and Eastern Europe (63%). The AUDIT study revealed a disparity between lipid screening and control in type 2 diabetic patients. Physicians reported that they treated patients without CVD less intensively than patients with CVD, suggesting that type 2 diabetes was not widely considered a coronary heart disease risk equivalent. A reassessment of guideline implementation is needed for physicians worldwide to improve lipid control to decrease cardiovascular risk in type 2 diabetes.

Key Words: lipids • hypercholesterolaemia • cardiovascular diseases • type 2 diabetes mellitus • guidelines • risk factors.

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The British Journal of Diabetes & Vascular Disease, Vol. 6, No. 1, 31-40 (2006)
DOI: 10.1177/14746514060060010401


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