Impact of physicians' beliefs and practices on cholesterol levels in patients with type 2 diabetes: A longitudinal assessment

• Published in: The American heart journal Vol. 149; no. 1; pp. 104 - 111
• Main Authors: FRANCIOSI, Monica, PELLEGRINI, Fabio, VALENTINI, Miriam, NICOLUCCI, Antonio, DE BERARDIS, Giorgia, BELFIGLIO, Maurizio, DI NARDO, Barbara, GREENFIELD, Sheldon, KAPLAN, Sherrie H, ROSSI, Maria C. E, SACCO, Michele, TOGNONI, Gianni
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier 2005
• Subjects: Attitude of Health Personnel; Biological and medical sciences; Cardiology. Vascular system; Cholesterol - blood; Cholesterol, LDL - blood; Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - complications; Female; Humans; Hyperlipidemias - complications; Hyperlipidemias - drug therapy; Hypolipidemic Agents - therapeutic use; Italy; Longitudinal Studies; Male; Medical sciences; Middle Aged; Practice Patterns, Physicians; Surveys and Questionnaires; Triglycerides - blood; Italy; Endocrinopathy; Belief; Type 2 diabetes; Human; Heart disease; Professional practice; Physician; Metabolic diseases; Cardiovascular disease; Level; Cholesterol
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/j.ahj.2004.06.011

Clinical trials demonstrate significant benefit from cholesterol management for patients with type 2 diabetes. The aim of this work was to explore the correlates of lipid management in patients with type 2 diabetes, including the subjective beliefs of physicians, setting of care, and patient-related factors.
This longitudinal outcomes research study involved 2359 patients with type 2 diabetes recruited by 111 general practitioners and 214 physicians practicing in diabetes clinics. Physicians' beliefs were assessed through a questionnaire administered when the study started in 1998. Main outcome measures were total cholesterol (TC) and LDL cholesterol (LDL-C) levels over 3 years and the proportion of patients treated with lipid-lowering drugs (LLDs).
Less than one-third of the physicians (27%) stated that they routinely started pharmacologic therapy for TC values > or =200 mg/dL (more aggressive), whereas 46% considered a TC level > or =240 mg/dL as the threshold for the initiation of treatment (less aggressive). During 3 years of observation, mean TC and LDL-C levels decreased from 215 +/- 40 mg/dL to 203 +/- 37 mg/dL and from 135 +/- 36 mg/dL to 126 +/- 35 mg/dL respectively, while the proportion of patients treated with LLDs increased from 13.2% to 24.6%; in particular, among individuals cared for by the more aggressive physicians, 30.0% were taking LLDs after 3 years, while only 17.7% of those followed by the less aggressive physicians and 18.1% of those followed by >1 physician were being treated with LLDs. Multilevel analysis showed that physicians' beliefs were an independent predictor of TC levels over the 3-year period. In patients treated with LLDs, TC levels decreased on average by 14%, and LDL-C levels decreased by 20%.
Our data show that physicians' beliefs in more aggressive management strategies will result in better mean TC values over a 3-year period.