Management of lipids: comparison between patients with diabetes and ischaemic heart disease

Ischaemic heart disease (IHD) is the commonest cause of death in patients with diabetes and there is an increasing awareness that macrovascular risk factors need aggressive treatment in patients with diabetes. However, there is concern that they may not benefit from screening and treatment as much as patients with IHD. We aimed to see whether in general practice patients with diabetes have their lipid profiles managed as appropriately as patients with IHD and as patients with diabetes in a hospital clinic. Three groups of patients were analysed: (i) general practice patients with IHD but without diabetes, (ii) GP patients with diabetes and (iii) diabetic patients attending a hospital clinic. Initial cholesterol, decision on drug treatment, testing for secondary causes and follow-up cholesterol concentrations were all recorded. In both general practice and hospital diabetic patients cholesterol checks were more likely than in IHD patients (85 and 88% versus 77%, p<0.05). Although diabetic patients were less likely than IHD patients to have raised cholesterol (35% versus 61%, p<0.01), in the general practice setting they were as likely as IHD patients to receive necessary treatment (23% versus 32%, not significant), although less likely than if they were a diabetic patient at a hospital clinic (54%, p<0.05). In a well organised general practice, lipid screening for diabetic patients can be as effective as for patients with IHD. In general practice and hospital, at least half of patients who may benefit from it are not receiving lipid lowering therapy. Compared to hospital, screening rates were equivalent, but patients were less likely to be started on medication in general practice. Copyright © 2000 John Wiley & Sons, Ltd.