Skip to main content

Advertisement

Log in

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

  • Original Article
  • Published:
Diabetology International Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  Google Scholar 

  12. Diabetes Epidemiology Research International Mortality Study Group. International evaluation of cause-specific mortality and IDDM. Diabetes Care. 1991;14:55–60.

    Article  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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. Japan Atherosclerosis Society. Japan Atherosclerosis Society (JAS) Guidelines for Prevention of Atherosclerotic Cardiovascular Diseases. 2017, 13–17.

  16. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2010;33(Suppl 1):S62–9.

    Article  PubMed Central  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  19. American Diabetes Association. Cardiovascular disease and risk management: standards of medical care in diabetes—2018. Diabetes Care. 2018;41(Suppl 1):S86–104.

    Article  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Ahmad Z. Statin intolerance. Am J Cardiol. 2014;113:1765–71.

    Article  CAS  PubMed  Google Scholar 

  30. Strandberg TE, Kolehmainen L, Vuorio A. Evaluation and treatment of older patients with hypercholesterolemia: a clinical review. JAMA. 2014;312:1136–44.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  33. Japan Diabetes Clinical Data Management Study Group. http://jddm.jp/data/index-2016.html.

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  36. Tada H, Kobayashi J. Optimal management target for non-high-density lipoprotein cholesterol. J Atheroscler Thromb. 2016;23:399–401.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  38. Japan Atherosclerosis Society (JAS) Guidelines for Prevention of Atherosclerotic Cardiovascular Diseases. 2017: 102–6.

Download references

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.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Tomoko Nakagami.

Ethics declarations

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.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hasegawa, Y., Nakagami, T., Oya, J. et al. Serum lipid management in patients with type 1 and type 2 diabetes: a hospital-based cohort study. Diabetol Int 10, 67–76 (2019). https://doi.org/10.1007/s13340-018-0365-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13340-018-0365-z

Keywords

Navigation