This study sought to quantify the extent to which cardiometabolic risk factor levels explained changes in drug treatment over a 1 year period in patients with type 2 diabetes. For that purpose, the authors assessed the influence of moderately and highly deteriorated cardiometabolic risk factors such as =140 and =160 mmHg for systolic blood pressure, =85 and =95 mmHg for diastolic blood pressure, =5.00 and =7.00 mmol/l for total cholesterol, and =7.0 and =8.5% for HbA1c on the decision to change antihypertensive, lipid-lowering, or glucose-lowering therapy in 3,029 primary care patients (mean age=66.4±12.3 years). The authors found that 58% of patients with elevated blood pressure, 71% of patients with high total cholesterol levels, and 21% of patients with high HbA1c levels remained untreated. For those already treated, 52% of patients controlled for systolic blood pressure, 81% of patients treated with lipid-lowering medication, and 43% of patients treated for glucose-lowering did not receive intensification of treatment. These results suggest that, based on cardiometabolic risk factors, glucose-lowering treatment was more likely to be changed by physicians than antihypertensive or lipid-lowering medications. The use of higher thresholds than those currently recommended by guidelines cannot entirely explain the low treatment rates of patients with elevated blood pressure and/or lipid disorders.
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