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Diabetology International

, Volume 10, Issue 1, pp 67–76 | Cite as

Serum lipid management in patients with type 1 and type 2 diabetes: a hospital-based cohort study

  • Yukiko Hasegawa
  • Tomoko NakagamiEmail author
  • Junko Oya
  • Chisato Isago
  • Moritoshi Kurita
  • Yuki Tanaka
  • Arata Ito
  • Reika Tsuzura
  • Naoki Hirota
  • Junnosuke Miura
  • Yasuko Uchigata
Original Article
  • 100 Downloads

Abstract

Introduction

Serum lipid management is important for patients with diabetes; however, it has not been examined in our specialized diabetes clinic.

Aims

The aim of the study was to assess the percentage of patients who did not achieve management targets (MT) for low-density lipoprotein-cholesterol (LDL-C), high-density lipoprotein-cholesterol (HDL-C) and triglycerides (TG), and explore factors related to failure to achieve lipid MT in Japanese patients with type 1 (T1D) and type 2 diabetes (T2D).

Methods

This cross-sectional study included 795 patients (35% men) with T1D and 4018 patients (60% men) with T2D attending our diabetes center. MTs for serum lipids were in accordance with the guidelines of the Japan Atherosclerosis Society. Logistic regression analysis was performed to identify factors related to failure to achieve MTs for serum lipids.

Results

The percentages of men/women who did not achieve MT for LDL-C were 34.1/31.8% in T1D and 40.5/52.7% in T2D. The corresponding values for TG were 35.1/14.0% in T1D and 50.1/47.9% in T2D, and for HDL-C were 2.5/0% in T1D and 8.6/2.9% in T2D. Increase in body mass index (BMI) and glycated hemoglobin (HbA1c) were significantly and independently associated with failure to achieve lipid MT in patients with T1D and T2D for both sexes.

Conclusions

The percentages of our patients who did not achieve serum lipid MT were relatively high in T1D and T2D, and higher HbA1c and BMI were associated with failure to achieve serum lipid MTs. More attention should be paid to lipid management in patients with diabetes especially who have higher HbA1c and BMI in our facility.

Keywords

Diabetes mellitus Management target for serum lipid LDL-cholesterol Triglyceride HDL-cholesterol 

Notes

Acknowledgements

The authors express their deep appreciation to the DIACET participants, and to the staff of the Department of Medicine and Ophthalmology, Diabetes Center, Tokyo Women’s Medical University School of Medicine.

Compliance with ethical standards

Conflicts of interest

The Diabetes Center of the Tokyo Women’s Medical University is supported through unrestricted research funding from Alcon, Astellas, AstraZeneca, Boehringer Ingelheim, Chugai, Daiichi Sankyo, Eizai, Eli Lilly, Kowa, Kyowa Hakko Kirin, Mitsubishi Tanabe, MSD, Nipro, Novartis, Novo Nordisk, Ono, Otsuka, Pfizer, Sanofi, Sumitomo Dainippon, Takeda, and Terumo.

Human rights statement

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions.

Informed consent

Informed consent or substitute for it was obtained from all patients for being included in the study.

References

  1. 1.
    Okamura T, Kadowaki T, Hayakawa T, Kita Y, Okayama A, Ueshima H, Nippon Data80 Research Group. What cause of mortality can we predict by cholesterol screening in the Japanese general population? J Intern Med. 2003;253:169–80.CrossRefGoogle Scholar
  2. 2.
    Okamura T, Hayakawa T, Kadowaki T, Kita Y, Okayama A, Ueshima H, The NIPPON DATA90 Research Group. The inverse relationship between serum high-density lipoprotein cholesterol level and all-cause mortality in a 9.6-year follow-up study in the Japanese general population. Atherosclerosis. 2006;184:143–50.CrossRefGoogle Scholar
  3. 3.
    Imano H, Noda H, Kitamura A, Sato S, Kiyama M, Sankai T, Ohira T, Nakamura M, Ikeda A, Shimamoto T, Iso H. Low-density lipoprotein cholesterol and risk of coronary heart disease among Japanese men and women: the Circulatory Risk in Communities Study (CIRCS). Prev Med. 2011;52:381–6.CrossRefGoogle Scholar
  4. 4.
    Iso H, Naito Y, Sato S, Kitamura A, Okamura T, Sankai T, Shimamoto T, Iuda M, Komachi Y. Serum triglycerides and risk of coronary heart disease among Japanese men and women. Am J Epidemiol. 2001;153:490–9.CrossRefGoogle Scholar
  5. 5.
    Imamura T, Doi Y, Arima H, Yonemoto K, Hata J, Tanizaki Y, Ibayashi S, Iida M, Kiyohara Y. LDL cholesterol and the development of stroke subtype and coronary heart disease in a general Japanese population: the Hisayama study. Stroke. 2009;40:382–8.CrossRefGoogle Scholar
  6. 6.
    Sone H, Tanaka S, Tanaka S, Iimuro S, Oida K, Yamasaki Y, Oikawa S, Ishibashi S, Katayama S, Ohashi Y, Akanuma Y, Yamada N, Japan Diabetes Complications Study Group. Serum level of triglycerides is a potent risk factor comparable to LDL cholesterol for coronary heart disease in Japanese patients with type 2 diabetes: subanalysis of the Japan Diabetes Complications Study (JDCS). J Clin Endocrinol Metab. 2011;96:3448–56.CrossRefGoogle Scholar
  7. 7.
    Turner RC, Millns H, Neil HA, Stratton IM, Manley SE, Matthews DR, Holman RR. Risk factors for coronary artery disease in non-insulin dependent diabetes mellitus: United Kingdom Prospective Diabetes Study (UKPDS: 23). BMJ. 1998;316:823–8.CrossRefGoogle Scholar
  8. 8.
    Cholesterol Treatment Trialists’ (CTT) Collaborators. Efficacy of cholesterol-lowering therapy in 18686 people with diabetes in 14 randomised trials of statins: a meta-analysis. Lancet. 2008;371:117–25.CrossRefGoogle Scholar
  9. 9.
    Tajima N, Kurata H, Nakaya N, Mizuno K, Ohashi Y, Kushiro T, Teramoto T, Uchiyama S, Nakamura H. Pravastatin reduces the risk for cardiovascular disease in Japanese hypercholesterolemic patients with impaired fasting glucose or diabetes: Diabetes subanalysis of the Management of Elevated Cholesterol in the Primary Prevention Group of Adult Japanese (MEGA) Study. Atherosclerosis. 2008;199:455–62.CrossRefGoogle Scholar
  10. 10.
    The FIELD study investigators. Effects of long-term fenofibrate therapy on cardiovascular events in 9795 people with type 2 diabetes mellitus (the FIELD study): randomized controlled trial. Lancet. 2005;366:1849–61.CrossRefGoogle Scholar
  11. 11.
    Diabetes Epidemiology Research International Mortality Study Group. Major cross-country differences in risk of dying for people with IDDM. Diabetes Care. 1991;14:49–54.CrossRefGoogle Scholar
  12. 12.
    Diabetes Epidemiology Research International Mortality Study Group. International evaluation of cause-specific mortality and IDDM. Diabetes Care. 1991;14:55–60.CrossRefGoogle Scholar
  13. 13.
    Morimoto A, Onda Y, Nishimura R, Sano H, Utsunomiya K, Tajima N, Diabetes Epidemiology Research International Mortality Study Group. Cause-specific mortality trends in a nationwide population-based cohort of childhood-onset type 1 diabetes in Japan during 35 years of follow-up: the DERI Mortality Study. Diabetologia. 2013;56:2171–5.CrossRefGoogle Scholar
  14. 14.
    The Japan Diabetes Society. Dyslipidemia Associated with Diabetes. Evidence-based Practice Guideline for the Treatment for Diabetes in Japan; 2013. http://www.jds.or.jp/common/fckeditor/editor/filemanager/connectors/php/transfer.php?file=/uid000025_474C323031335F656E2D31352E706466.
  15. 15.
    Japan Atherosclerosis Society. Japan Atherosclerosis Society (JAS) Guidelines for Prevention of Atherosclerotic Cardiovascular Diseases. 2017, 13–17.Google Scholar
  16. 16.
    American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2010;33(Suppl 1):S62–9.CrossRefGoogle Scholar
  17. 17.
    Tajima N, Nishimura R, Izumi K, Hayashino Y, Origasa H, Noda M, Ueki K, For the Diabetes Registry Configuration Committee, The Japanese Diabetes Society. A large-scale, observational study to investigate the current status of diabetes complications and their prevention in Japan: research outline and baseline data for type 2 diabetes—JDCP study 1. Diabetol Int. 2015;6:243–51.CrossRefGoogle Scholar
  18. 18.
    Nishimura R, Izumi K, Hayashino Y, Origasa H, Noda M, Ueki K, Tajima N, For the Diabetes Registry Configuration Committee, Japanese Diabetes Society. A large-scale observational study to investigate the current status of diabetes complications and their prevention in Japan: research outline and baseline data for type 1 diabetes—JDCP study 2. Diabetol Int. 2016;7:4–11.CrossRefGoogle Scholar
  19. 19.
    American Diabetes Association. Cardiovascular disease and risk management: standards of medical care in diabetes—2018. Diabetes Care. 2018;41(Suppl 1):S86–104.CrossRefGoogle Scholar
  20. 20.
    Cholesterol Treatment Trialists’ (CTT) Collaborators, Kearney PM, Blackwell L, Collins R, Keech A, Simes J, Peto R, Armitage J, Baigent C. Efficacy of cholesterol-lowering therapy in 18 686 people with diabetes in 14 randomised trials of statins: a meta-analysis. Lancet. 2008;371:117–25.CrossRefGoogle Scholar
  21. 21.
    Coleman RL, Stevens RJ, Retnakaran R, Holman RR. Framingham, SCORE, and DECODE risk equations do not provide reliable cardiovascular risk estimates in type 2 diabetes. Diabetes Care. 2007;30:1292–3.CrossRefGoogle Scholar
  22. 22.
    Chamnan P, Simmons RK, Sharp SJ, Griffin SJ, Wareham NJ. Cardiovascular risk assessment scores for people with diabetes: a systematic review. Diabetologia. 2009;52:2001–4.CrossRefGoogle Scholar
  23. 23.
    Stevens RJ, Kothari V, Adler AI, Stratton IM, United Kingdom Prospective Diabetes Study (UKPDS) Group. The UKPDS risk engine: a model for the risk of coronary heart disease in type II diabetes (UKPDS 56). Clin Sci (Lond). 2001;101:671–9.CrossRefGoogle Scholar
  24. 24.
    Tanaka S, Tanaka S, Iimuro S, Yamashita H, Katayama S, Akanuma Y, Yamada N, Araki A, Ito H, Sone H, Ohashi Y, Japan Diabetes Complications Study Group, Japanese Elderly Diabetes Intervention Trial Group. Predicting macro- and microvascular complications in type 2 diabetes: the Japan Diabetes Complications Study/the Japanese Elderly Diabetes Intervention Trial risk engine. Diabetes Care. 2013;36:1193–9.CrossRefGoogle Scholar
  25. 25.
    Araki A, Iimuro S, Sakurai T, Umegaki H, Lijima K, Nakano H, Oba K, Yokono K, Sone H, Yamada N, Ako J, Kozaki K, Miura H, Kashiwagi A, Kikkawa R, Yoshimura Y, Nakano T, Ohashi Y, Ito H, the Japanese Elderly Intervention Trial Research Group. Non-high density lipoprotein cholesterol: An important predictor of stroke and diabetes-related mortality in Japanese elderly diabetic patients. Geriatr Gerontol Int. 2012;12(Suppl. 1):18–28.CrossRefGoogle Scholar
  26. 26.
    Shinozaki T, Matsuyama Y, Iimuro S, Umegaki H, Sakurai T, Araki A, Ohashi Y, Ito H, the Japanese Elderly Intervention Trial Research Group. Effective prevention of cardiovascular disease and diabetes-related events with atorvastatin in Japanese elderly patients with type 2 diabetesmellitus: adjusting for treatment changes using a marginal structural proportional hazards model and a rank-preserving structural failure time model. Geriatr Gerontol Int. 2012;12(Suppl. 1):88–102.CrossRefGoogle Scholar
  27. 27.
    Kubo M, Kiyohara Y, Kato I, Tanigaki Y, Arima H, Tanaka K, Nakamura H, Okubo K, Iida M. Trends in the incidence, mortality, and survival rate of cardiovascular disease in a Japanese community: the Hisayama study. Stroke. 2003;34:2349–54.CrossRefGoogle Scholar
  28. 28.
    Fonseca MIH, da Silva IT, Ferreria SRG. Impact of menopause and diabetes on atherogenic lipid profile: is it worth to analyse lipoprotein subfractions to assess cardiovascular risk in women? Diabetol Metab Syndr. 2017;9:22.CrossRefGoogle Scholar
  29. 29.
    Ahmad Z. Statin intolerance. Am J Cardiol. 2014;113:1765–71.CrossRefGoogle Scholar
  30. 30.
    Strandberg TE, Kolehmainen L, Vuorio A. Evaluation and treatment of older patients with hypercholesterolemia: a clinical review. JAMA. 2014;312:1136–44.CrossRefGoogle Scholar
  31. 31.
    ACCORD Study Group, Ginsberg HN, Elam MB, Lovato LC, Crouse JR 3rd, Leiter LA, Linz P, Friedewald WT, Buse JB, Gerstein HC, Probstfield J, Grimm RH, Ismail-Beigi F, Bigger JT, Goff DC Jr, Cushman WC, Simons-Morton DG, Byington RP. Effects of combination lipid therapy in Type 2 diabetes mellitus. N Engl J Med. 2010;362:1563–74.CrossRefGoogle Scholar
  32. 32.
    Arai K, Yokoyama H, Okuguchi F, Yamazaki K, Takagi H, Hirao K, Kobayashi M, Japan Diabetes Clinical Data Management Study Group. Association between body mass index and core components of metabolic syndrome in 1486 patients with type 1 diabetes mellitus in Japan (JDDM 13). Endocr J. 2008;55:1025–32.CrossRefGoogle Scholar
  33. 33.
    Japan Diabetes Clinical Data Management Study Group. http://jddm.jp/data/index-2016.html.
  34. 34.
    Iso H, Imano H, Yamagishi K, Tamagishi K, Ohira T, Cui R, Noda H, Sato S, Kiyama M, Okada T, Hitsumoto S, Tanigawa T, Kitamura A, CIRCS Investigators. Fasting and non-fasting triglycerides and risk of ischemic cardiovascular disease in Japanese men and women: the Circulatory Risk in Communities Study (CIRCS). Atherosclerosis. 2014;237:361–8.CrossRefGoogle Scholar
  35. 35.
    Carstensen M, Thomsen C, Gotzsche O, Holst JJ, Schrezenmeir J, Hermansen K. Differential postprandial lipoprotein responses in type 2 diabetic men with and without clinical evidence of a former myocardial infarction. Rev Diabet Stud. 2004;1:175–84.CrossRefGoogle Scholar
  36. 36.
    Tada H, Kobayashi J. Optimal management target for non-high-density lipoprotein cholesterol. J Atheroscler Thromb. 2016;23:399–401.CrossRefGoogle Scholar
  37. 37.
    Cui Y, Blumenthal R, Flaws J, Whiteman MK, Langenberg P, Bachorik PS, Bush TL. Non-high-density lipoprotein cholesterol level as a predictor of cardiovascular disease mortality. Arch Intern Med. 2001;161:1413–9.CrossRefGoogle Scholar
  38. 38.
    Japan Atherosclerosis Society (JAS) Guidelines for Prevention of Atherosclerotic Cardiovascular Diseases. 2017: 102–6.Google Scholar

Copyright information

© The Japan Diabetes Society 2018

Authors and Affiliations

  • Yukiko Hasegawa
    • 1
  • Tomoko Nakagami
    • 1
    Email author
  • Junko Oya
    • 1
  • Chisato Isago
    • 1
  • Moritoshi Kurita
    • 1
  • Yuki Tanaka
    • 1
  • Arata Ito
    • 1
  • Reika Tsuzura
    • 1
  • Naoki Hirota
    • 1
  • Junnosuke Miura
    • 1
  • Yasuko Uchigata
    • 1
  1. 1.Diabetes CenterTokyo Women’s Medical University School of MedicineTokyoJapan

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