Open Access Highly Accessed Original investigation

Personal attributes that influence the adequate management of hypertension and dyslipidemia in patients with type 2 diabetes. Results from the DIAB-CORE Cooperation

Ina-Maria Rückert1*, Werner Maier2, Andreas Mielck2, Sabine Schipf3, Henry Völzke3, Alexander Kluttig4, Karin-Halina Greiser45, Klaus Berger6, Grit Müller6, Ute Ellert7, Hannelore Neuhauser7, Wolfgang Rathmann8, Teresa Tamayo8, Susanne Moebus9, Silke Andrich9 and Christa Meisinger110

Author Affiliations

1 Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH) and German Center for Diabetes Research (DZD e.V.), Ingolstädter Landstrasse 1, D-85764, München/Neuherberg, Germany

2 Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany

3 Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany

4 Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Saale, Germany

5 German Cancer Research Centre, Division of Cancer Epidemiology, Heidelberg, Germany

6 Institute of Epidemiology and Social Medicine, University of Muenster, Muenster, Germany

7 Department of Epidemiology and Health Reporting, Robert-Koch-Institute, Berlin, Germany

8 Institute of Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes, Research at Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany

9 Institute of Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany

10 MONICA/KORA Myocardial Infarction Registry, Central Hospital of Augsburg, Augsburg, Germany

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Cardiovascular Diabetology 2012, 11:120  doi:10.1186/1475-2840-11-120

Published: 5 October 2012

Abstract

Background

Hypertension and dyslipidemia are often insufficiently controlled in persons with type 2 diabetes (T2D) in Germany. In the current study we evaluated individual characteristics that are assumed to influence the adequate treatment and control of hypertension and dyslipidemia and aimed to identify the patient group with the most urgent need for improved health care.

Methods

The analysis was based on the DIAB-CORE project in which cross-sectional data from five regional population-based studies and one nationwide German study, conducted between 1997 and 2006, were pooled. We compared the frequencies of socio-economic and lifestyle factors along with comorbidities in hypertensive participants with or without the blood pressure target of < 140/90 mmHg. Similar studies were also performed in participants with dyslipidemia with and without the target of total cholesterol/HDL cholesterol ratio < 5. Furthermore, we compared participants who received antihypertensive/lipid lowering treatment with those who were untreated. Univariable and multivariable logistic regression models were used to assess the odds of potentially influential factors.

Results

We included 1287 participants with T2D of whom n = 1048 had hypertension and n = 636 had dyslipidemia. Uncontrolled blood pressure was associated with male sex, low body mass index (BMI), no history of myocardial infarction (MI) and study site. Uncontrolled blood lipid levels were associated with male sex, no history of MI and study site. The odds of receiving no pharmacotherapy for hypertension were significantly greater in men, younger participants, those with BMI < 30 kg/m2 and those without previous MI or stroke. Participants with dyslipidemia received lipid lowering medication less frequently if they were male and had not previously had an MI. The more recent studies HNR and CARLA had the greatest numbers of well controlled and treated participants.

Conclusion

In the DIAB-CORE study, the patient group with the greatest odds of uncontrolled co-morbidities and no pharmacotherapy was more likely comprised of younger men with low BMI and no history of cardiovascular disease.

Keywords:
Type 2 Diabetes; Comorbidities; Hypertension; Dyslipidemia; Adherence to guidelines; Sex differences