Iedere patiënt met diabetes mellitus type 2 een statine, tenzij…

Abstract

De Grauw W, Bakx C, Van Gerwen W, All Type 2 diabetic patients need lipid-lowering therapy, unless…. Different definitions in two guidelines issued by the Dutch College of General Practitioners. Huisarts Wet 2007;50(4):144-7. Aim The revised Type 2 diabetes mellitus and cardiovascular management guidelines issued by the Dutch College of General Practitioners recommend lipid-lowering therapy in all Type 2 diabetic patients unless their 10-year cardiovascular mortality risk is low (less than 5%). Both guidelines use different ways of assessing this risk. We investigated how many patients fulfil the ‘unless condition’ in both guidelines. Method Cross-sectional survey in the Academic Research Network of the Department of Family Medicine, University Medical Centre Nijmegen (CMR/NMP). We assessed which patients fulfilled the condition of low-risk cardiovascular mortality as defined by the guidelines. Results 470 Type 2 diabetic patients were not known to be affected by cardiovascular morbidity and were not treated with lipid-lowering therapy. 6% fulfilled the ‘unless-condition’ defined by the diabetes mellitus guidelines and 22% as defined by the cardiovascular management guidelines. Conclusion 80-95% of the Type 2 diabetic patients not known to be affected by cardiovascular morbidity and not treated with lipid-lowering therapy will be eligible for lipid-lowering therapy following the revised Type 2 diabetes mellitus and cardiovascular management guidelines of the Dutch College of General Practitioners. Notwithstanding this high percentage we prefer individual tailoring rather than the recommendation to prescribe lipid-lowering therapy indiscriminately for all Type 2 diabetic patients. However, both guidelines use different definitions of low risk, thereby adding to the confusion.