TITLE:
What Happens to Modifiable Cardiovascular Risk Factors over Time in Type 2 Diabetes? Experience from a Developing Country under Standard of Care Conditions
AUTHORS:
Raya S. Zreik, Haytham I. Salti, Ibrahim S. Salti, Roula Boukhalil, Tamer Haddad, Mona P. Nasrallah
KEYWORDS:
Cardiovascular Risk Factors, Diabetes Outpatient Clinic, Lebanon, T2DM
JOURNAL NAME:
Journal of Diabetes Mellitus,
Vol.6 No.4,
November
25,
2016
ABSTRACT: Introduction: The complications of diabetes mellitus
are the main reason for the morbidity associated with this condition, its cost,
and its effect on quality of life. We have previously reported on the high
prevalence of complications on a cohort of diabetic subjects. In the current
study, we inquire what happens to the risk factors associated with these
complications over time. Methods: The study is a prospective observational
report over a two-year period where patients presented to the outpatient clinic
for their usual care and had laboratory tests, retinal exams, and clinical
assessment. They were treated as per American Diabetes Association guidelines
in the outpatient department of the American University of Beirut. Results: Out
of 220 subjects, 200 completed the two-year evaluation. There was no change in
metabolic indices such as HbA1C, BMI, or smoking rates. However, there was
mild, but significant improvement in LDL-C levels and blood pressure control.
In parallel, there was an increase in the use of statins and ARB/ACEI category.
However, their use remained much lower than in the reported literature. The
population fared worse than the National Health Assessment and Nutrition
Examination Survey (NHANES) population in most diabetes quality of care
measures. The predicted 10-year vascular risk was 19%, similar to the
calculated risk in a German population study. Conclusion: The lack of significant
metabolic improvement points to a lack of effective lifestyle implementation
measures, as well as to an under utilization of medical therapy. The approach
to complications prevention needs to be more intense and multidisciplinary in
nature in order to improve the patients’ outcome.