The impact of outpatient diabetes management on serum lipids in urban African-Americans with type 2 diabetes

Diane M. Erdman, Curtiss B. Cook, Kurt J. Greenlund, Wayne H. Giles, Imad El-Kebbi, Gina J. Ryan, Daniel L. Gallina, David C. Ziemer, Virginia G. Dunbar, Lawrence S. Phillips

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

OBJECTIVE - Treating dyslipidemia in diabetic patients is essential, particularly among minority populations with increased risk of complications. Because little is known about the impact of outpatient diabetes management on lipid outcomes, we examined changes in lipid profiles in urban African-Americans who attended a structured diabetes care program. RESEARCH DESIGN AND METHODS - A retrospective analysis of initial and 1-year follow-up lipid values was conducted among patients selected from a computerized registry of an urban outpatient diabetes clinic. The independent effects of lipid-specific medications, glycemic control, and weight loss on serum total cholesterol, LDL cholesterol, HDL cholesterol, and triglyceride levels were evaluated by analysis of covariance and multiple linear regression. RESULTS - In 345 patients (91% African-American and 95% with type 2 diabetes), HbA1c decreased from 9.3% at the initial visit to 8.2% at 1 year (P < 0.001); total and LDL cholesterol and triglyceride levels were significantly lower, and HDL cholesterol was higher. After stratifying based on use of lipid-specific therapy, different outcomes were observed. In 243 patients not taking dyslipidemia medications, average total cholesterol, LDL cholesterol, and triglyceride concentrations at 1 year were similar to initial values, whereas in 102 patients receiving pharmacotherapy, these lipid levels were all lower at 1 year relative to baseline (P < 0.001). Mean HDL cholesterol increased regardless of lipid treatment status (P < 0.001). After adjusting for other variables, changes in LDL cholesterol concentration were associated only with use of lipid-specific agents (P = 0.003), whereas improved HbA1c and weight loss had no independent effect. Lipid therapy, improved glycemic control, and weight loss were not independently related to changes in HDL cholesterol and therefore could not account for the positive changes observed. Use of lipid-directed medications, improvement in glycemic control, and weight loss all resulted in significant declines in triglyceride levels but only improved HbA1c and weight loss had an independent effect. CONCLUSIONS - Among urban African-Americans, diabetes management led to favorable changes in HDL cholesterol and triglyceride levels, but improved glycemic control and weight loss had no independent effect on LDL cholesterol concentration. Initiation of pharmacologic therapy to treat high LDL cholesterol levels should be considered early in the course of diabetes management to reach recommended targets and reduce the risk of cardiovascular complications in this patient population.

Original languageEnglish (US)
Pages (from-to)9-15
Number of pages7
JournalDiabetes Care
Volume25
Issue number1
DOIs
StatePublished - Jan 2002
Externally publishedYes

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African Americans
Type 2 Diabetes Mellitus
Outpatients
Lipids
LDL Cholesterol
Weight Loss
Serum
HDL Cholesterol
Triglycerides
Dyslipidemias
Cholesterol
Therapeutics
Ambulatory Care Facilities
Hypercholesterolemia
Population
Registries
Linear Models
Research Design
Drug Therapy

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism

Cite this

Erdman, D. M., Cook, C. B., Greenlund, K. J., Giles, W. H., El-Kebbi, I., Ryan, G. J., ... Phillips, L. S. (2002). The impact of outpatient diabetes management on serum lipids in urban African-Americans with type 2 diabetes. Diabetes Care, 25(1), 9-15. https://doi.org/10.2337/diacare.25.1.9

The impact of outpatient diabetes management on serum lipids in urban African-Americans with type 2 diabetes. / Erdman, Diane M.; Cook, Curtiss B.; Greenlund, Kurt J.; Giles, Wayne H.; El-Kebbi, Imad; Ryan, Gina J.; Gallina, Daniel L.; Ziemer, David C.; Dunbar, Virginia G.; Phillips, Lawrence S.

In: Diabetes Care, Vol. 25, No. 1, 01.2002, p. 9-15.

Research output: Contribution to journalArticle

Erdman, DM, Cook, CB, Greenlund, KJ, Giles, WH, El-Kebbi, I, Ryan, GJ, Gallina, DL, Ziemer, DC, Dunbar, VG & Phillips, LS 2002, 'The impact of outpatient diabetes management on serum lipids in urban African-Americans with type 2 diabetes', Diabetes Care, vol. 25, no. 1, pp. 9-15. https://doi.org/10.2337/diacare.25.1.9
Erdman, Diane M. ; Cook, Curtiss B. ; Greenlund, Kurt J. ; Giles, Wayne H. ; El-Kebbi, Imad ; Ryan, Gina J. ; Gallina, Daniel L. ; Ziemer, David C. ; Dunbar, Virginia G. ; Phillips, Lawrence S. / The impact of outpatient diabetes management on serum lipids in urban African-Americans with type 2 diabetes. In: Diabetes Care. 2002 ; Vol. 25, No. 1. pp. 9-15.
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AU - Giles, Wayne H.

AU - El-Kebbi, Imad

AU - Ryan, Gina J.

AU - Gallina, Daniel L.

AU - Ziemer, David C.

AU - Dunbar, Virginia G.

AU - Phillips, Lawrence S.

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N2 - OBJECTIVE - Treating dyslipidemia in diabetic patients is essential, particularly among minority populations with increased risk of complications. Because little is known about the impact of outpatient diabetes management on lipid outcomes, we examined changes in lipid profiles in urban African-Americans who attended a structured diabetes care program. RESEARCH DESIGN AND METHODS - A retrospective analysis of initial and 1-year follow-up lipid values was conducted among patients selected from a computerized registry of an urban outpatient diabetes clinic. The independent effects of lipid-specific medications, glycemic control, and weight loss on serum total cholesterol, LDL cholesterol, HDL cholesterol, and triglyceride levels were evaluated by analysis of covariance and multiple linear regression. RESULTS - In 345 patients (91% African-American and 95% with type 2 diabetes), HbA1c decreased from 9.3% at the initial visit to 8.2% at 1 year (P < 0.001); total and LDL cholesterol and triglyceride levels were significantly lower, and HDL cholesterol was higher. After stratifying based on use of lipid-specific therapy, different outcomes were observed. In 243 patients not taking dyslipidemia medications, average total cholesterol, LDL cholesterol, and triglyceride concentrations at 1 year were similar to initial values, whereas in 102 patients receiving pharmacotherapy, these lipid levels were all lower at 1 year relative to baseline (P < 0.001). Mean HDL cholesterol increased regardless of lipid treatment status (P < 0.001). After adjusting for other variables, changes in LDL cholesterol concentration were associated only with use of lipid-specific agents (P = 0.003), whereas improved HbA1c and weight loss had no independent effect. Lipid therapy, improved glycemic control, and weight loss were not independently related to changes in HDL cholesterol and therefore could not account for the positive changes observed. Use of lipid-directed medications, improvement in glycemic control, and weight loss all resulted in significant declines in triglyceride levels but only improved HbA1c and weight loss had an independent effect. CONCLUSIONS - Among urban African-Americans, diabetes management led to favorable changes in HDL cholesterol and triglyceride levels, but improved glycemic control and weight loss had no independent effect on LDL cholesterol concentration. Initiation of pharmacologic therapy to treat high LDL cholesterol levels should be considered early in the course of diabetes management to reach recommended targets and reduce the risk of cardiovascular complications in this patient population.

AB - OBJECTIVE - Treating dyslipidemia in diabetic patients is essential, particularly among minority populations with increased risk of complications. Because little is known about the impact of outpatient diabetes management on lipid outcomes, we examined changes in lipid profiles in urban African-Americans who attended a structured diabetes care program. RESEARCH DESIGN AND METHODS - A retrospective analysis of initial and 1-year follow-up lipid values was conducted among patients selected from a computerized registry of an urban outpatient diabetes clinic. The independent effects of lipid-specific medications, glycemic control, and weight loss on serum total cholesterol, LDL cholesterol, HDL cholesterol, and triglyceride levels were evaluated by analysis of covariance and multiple linear regression. RESULTS - In 345 patients (91% African-American and 95% with type 2 diabetes), HbA1c decreased from 9.3% at the initial visit to 8.2% at 1 year (P < 0.001); total and LDL cholesterol and triglyceride levels were significantly lower, and HDL cholesterol was higher. After stratifying based on use of lipid-specific therapy, different outcomes were observed. In 243 patients not taking dyslipidemia medications, average total cholesterol, LDL cholesterol, and triglyceride concentrations at 1 year were similar to initial values, whereas in 102 patients receiving pharmacotherapy, these lipid levels were all lower at 1 year relative to baseline (P < 0.001). Mean HDL cholesterol increased regardless of lipid treatment status (P < 0.001). After adjusting for other variables, changes in LDL cholesterol concentration were associated only with use of lipid-specific agents (P = 0.003), whereas improved HbA1c and weight loss had no independent effect. Lipid therapy, improved glycemic control, and weight loss were not independently related to changes in HDL cholesterol and therefore could not account for the positive changes observed. Use of lipid-directed medications, improvement in glycemic control, and weight loss all resulted in significant declines in triglyceride levels but only improved HbA1c and weight loss had an independent effect. CONCLUSIONS - Among urban African-Americans, diabetes management led to favorable changes in HDL cholesterol and triglyceride levels, but improved glycemic control and weight loss had no independent effect on LDL cholesterol concentration. Initiation of pharmacologic therapy to treat high LDL cholesterol levels should be considered early in the course of diabetes management to reach recommended targets and reduce the risk of cardiovascular complications in this patient population.

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