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Enhancing Diabetes Knowledge in Patients

Enhancing Diabetes Knowledge in Patients

The National Diabetes Education Program (NDEP) was established, in part, to improve treatment and outcomes for people with diabetes by increasing knowledge of A1C, blood pressure (BP), and LDL cholesterol; together, these components make up the “ABCs” of diabetes. Few studies, however, have explored patient knowledge of their ABC levels and the association between having this knowledge and adhering to treatment recommendations for each of the ABC components. ABC Diabetes Knowledge From Patients Still Lacking In Diabetes Care, my colleagues and I had a study published in which we sought to assess patient knowledge of ABC levels and the association between this knowledge and meeting the ABC target goals. We also evaluated the association between specific demographic and diabetes-related factors and ABC knowledge. The purpose was to see if these data could help physicians and researchers identify high-risk patients who had particularly low knowledge.   According to our findings, knowledge of the ABCs was suboptimal. Among patients with diabetes, our data showed that: 48% could report their last A1C level. 63% could report their BP level. 22% could report their last LDL level. Knowledge was lower among Mexican Americans when compared with non-Hispanic whites and in people with less income and education. Having routine foot exams performed by physicians in the past year was associated with higher A1C knowledge. Nearly 20% of study participants reported that their healthcare provider did not specify an A1C goal. About three of every five participants reported that they were not informed of their BP or LDL cholesterol goals (47% and 41%, respectively). Significant Implications on Controlling Diabetes Physician communication of the ABC goals...

Attaining LDL Cholesterol Goals After AMI

One-third of patients with acute myocardial infarction (AMI) and baseline hyperlipidemia do not appear to reach an LDL cholesterol (LDL-C) goal of less than 100 mg/dL after 6 months, according to American research. Patients who did not meet the LDL-C goal during this timeframe were more often discharged without a statin than those who attained the goal (21% vs 9%). Abstract: American Heart Journal, January...

A New Guideline for Treating Hypertriglyceridemia

Hypertriglyceridemia can substantially increase the likelihood of patients developing heart disease when compared with those who have normal triglyceride levels. While treatment strategies for this condition are well established, its causes differ from patient to patient, as do the risks they pose to each individual. Clinical practice guidelines from the Endocrine Society on hypertriglyceridemia were published in the September 2012 Journal of Clinical Endocrinology and Metabolism (view and print guideline summary here). They recommend that more attention be paid to how personal history, physiology, and lifestyle interact to affect risk. “In recent years, much of the focus surrounding lipids has concentrated on cholesterol,” explains Lars Berglund, MD, PhD, who chaired the Endocrine Society task force that developed the most recent guidelines. “Although there are evidence–based guidelines from respected medical associations that address lipids, data on the complex role of triglycerides in heart disease continue to accumulate. Considering this recent emergence of data on triglycerides, it was important to focus on a guideline that specifically discusses this component of heart disease care.” Individualized Approach with Elevated Triglycerides Dr. Berglund stresses that clinicians should not view elevated fasting triglyceride levels as a standalone factor. “Triglycerides should be looked at in the context of other risk factors for cardiovascular disease (CVD) and metabolic disease,” he says. “Assessment should include the evaluation of secondary causes of hyperlipidemia, including endocrine conditions and medications [Table 1]. Central obesity, hypertension, abnormalities of glucose metabolism, liver dysfunction, and family history of dyslipidemia and CVD should be assessed.” For example, patients with triglyceride levels in the moderate range—200 mg/dl to 999 mg/ dl—may have changes in HDL and...
In the LDL World, Size Matters

In the LDL World, Size Matters

At MSN Health, Prevention author Arthur Agatston, MD, is trying to shed some light on what he says is “a paradox that has long puzzled doctors.” Research has shown that roughly half of all people who have heart attacks have perfectly normal cholesterol levels. Dr. Agatston references a patient with a total cholesterol level of 145 mg/dL who had suffered two heart attacks by age 48, and another patient with a total cholesterol level of about 300 mg/dL who at age 70 did not have plaque in her coronary arteries. While total cholesterol numbers are important, is seems that the size of the actual cholesterol particles is just as important, according to Dr. Agatston. Not all LDL actually gets deposited in arterial walls, causing plaque buildup. While small LDL particles easily puncture the arterial lining (causing plaque deposits), large particles actually bounce off arterial walls harmlessly. Dr. Agatston proposes that physicians test patients for LDL particle size. Tests for LDL particle have been clinically available for roughly 20 years and widely available for 5 years, according to Dr. Agatston. Plus, the tests are typically covered by health insurance. They are graded differently, depending on the test, but most provide a reading of small, medium, or large. For patients with small LDL particles, lifestyle and diet changes and/or medication can help change those small particles to larger, safer particles. According to Dr. Agatston, fibrates—which are used to decrease triglycerides and increase HDL—can also increase LDL particle size. Despite this knowledge, very few patients are tested for particle size. Physician’s Weekly wants to know… • Do you test patients for LDL...
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