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July 21, 1989, Vol 262, No. 3 >
ARTICLE | July 21, 1989

Lack of Awareness and Treatment of Hyperlipidemia in Type II Diabetes in a Community Survey FREE

Michael P. Stern, MD; Judith K. Patterson, PhD; Steven M. Haffner, MD; Helen P. Hazuda, PhD; Braxton D. Mitchell, PhD
[+] Author Affiliations

Reprint requests to the Department of Medicine, University of Texas Health Science Center, 7703 Floyd Curl Dr, San Antonio, TX 78284 (Dr Stern).


JAMA. 1989;262(3):360-364. doi:10.1001/jama.1989.03430030048032
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References

Cardiovascular disease is the leading cause of morbidity, disability, and death among patients with type II (non—insulin-dependent) diabetes mellitus. Moreover, hyperlipidemia is also common among these patients. Despite this, there are virtually no data regarding the level of awareness and treatment of hyperlipidemia among diabetic subjects at the community level. We therefore examined 374 Mexican-Americans and 86 non-Hispanic whites with type II diabetes identified in an epidemiologic survey that involved 3279 Mexican-Americans and 1847 non-Hispanic whites who resided in San Antonio, Tex. More than 40% of the diabetic subjects were hyperlipidemic according to the criteria of the National Cholesterol Education Program, and an additional 23% had hypertriglyceridemia and/or low levels of high-density lipoprotein cholesterol. By contrast, less than one fourth of the nondiabetic subjects were hyperlipidemic. Only approximately 25% of non-Hispanic whites with diabetes were aware of their hyperlipidemia, and less than 10% were receiving treatment. Awareness and treatment were even less frequent among Mexican-Americans with diabetes. Community physicians should be encouraged to give early attention to the management of lipid disorders in their diabetic patients.

(JAMA. 1989;262:360-364)

REFERENCES

1 +
Blood Pressure Levels of Persons 6-74 Years: United States, 1971-74 . Washington, DC: National Center for Health Statistics; 1977;. US Dept of Health, Education, and Welfare publication (HRA) 78-1648. Vital and Health Statistics Series II, National Health Survey No. 203.
2 +
Shoenberger JA, Stamler J, Shekelle RB, Shekelle S.  Current status of hypertension control in an industrial population . JAMA. 1972;;222:559-562.
3 +
Wilber JA.  The problem of undetected and untreated hypertension in the community . Bull NY Acad Med. 1973;;49:510-520.
4 +
Veterans Administration Cooperative Study Group on Anthihypertensive Agents.  Effects of treatment on morbidity in hypertension: results in patients with diastolic blood pressure averaging 115 through 129 mm Hg . JAMA. 1967;;202:116-122.
5 +
Veterans Administration Cooperative Study Group on Antihypertensive Agents.  Effects of treatment on morbidity in hypertension, II: results in patients with diastolic blood pressure averaging 90 through 114 mm Hg . JAMA. 1970;;213:1143-1152.
6 +
Hypertension Detection and Follow-up Program Cooperative Group.  Five-year findings of the Hypertension Detection and Follow-up Program, I: reduction in mortality of persons with high blood pressure, including mild hypertension . JAMA. 1979;;242:2562-2571.
7 +
Stamler J, Stamler R, Riedlinger WF, Algera G, Roberts RH.  Hypertension screening of 1 million Americans: Community Hypertension Evaluation Clinic (CHEC) Program, 1973 through 1975 . JAMA. 1976;;235:2299-2306.
8 +
Hypertension Detection and Follow-up Program Cooperative Group.  Blood pressure studies in 14 communities: a two-stage screen for hypertension . JAMA. 1977;;237:2385-2391.
9 +
Borhani NO. Mortality Trend in Hypertension, United States, 1950-1976: Proceedings of the Conference on the Decline in Coronary Heart Disease Mortality . Washington, DC: US Dept of Health, Education, and Welfare; 1979;. National Institutes of Health publication 79-1610.
10 +
Franco LJ, Stern MP, Rosenthal M, Haffner SM, Hazuda HP, Comeaux PJ.  Prevalence, detection and control of hypertension in a biethnic community: the San Antonio Heart Study . Am J Epidemiol. 1985;;121:684-696.
11 +
Dayton S, Pearce ML, Hashimoto S, Dixon WJ, Tomiyasu U.  A controlled clinical trial of a diet high in unsaturated fat in preventing complications of atherosclerosis . Circulation. 1969;;40( (suppl 2) ): II-1-63.
12 +
Miettinen M, Turpeinen O, Karvonen MJ, Elosuo R, Paavilainen E.  Effect of cholesterol-lowering diet on mortality from coronary heart disease and other causes: a twelve-year clinical trial in men and women . Lancet. 1972;;2:835-838.
13 +
Lipid Research Clinics Program.  The Lipid Research Clinics Coronary Primary Prevention Trial results, I: reduction in incidence of coronary heart disease . JAMA. 1984;;251:351-364.
14 +
Hjermann I, Velve Byre K, Holme I, Leren P.  Effect of diet and smoking intervention on the incidence of coronary heart disease: report from the Oslo Study Group of a randomized trial in healthy men . Lancet. 1981;;2:1303-1310.
15 +
The Coronary Drug Project Research Group.  Clofibrate and niacin in coronary heart disease . JAMA. 1975;;231:360-381.
16 +
Canner PL, Berge KG, The Coronary Drug Project Research Group, et al.  Fifteen year mortality in Coronary Drug Project patients: long-term benefit with niacin . J Am Coll Cardiol. 1986;; 8:1245-1255.
17 +
Frick MH, Elo O, Haapa K, et al.  Helsinki Heart Study: primary prevention trial with gemfibrozil in middle-aged men with dyslipidemia. Safety of treatment, changes in risk factors, and incidence of coronary heart disease . N Engl J Med. 1987;;317:1237-1245.
18 +
Blankenhorn DH, Nessim SA, Johnson RL, Sanmarco ME, Azen SP, Cashin-Hemphill L.  Beneficial effects of combined colestipol-niacin therapy on coronary atherosclerosis and coronary venous bypass grafts . JAMA. 1987;;257:3233-3240.
19 +
Pugh JA, Stern MP, Haffner SM, Hazuda HP, Patterson JK.  Detection and treatment of hypercholesterolemia in a biethnic community, 1979-85 . J Gen Intern Med. 1988;;3:331-336.
20 +
 The Expert Panel. Report of the National Cholesterol Education Program expert panel on detection, evaluation, and treatment of high blood cholesterol in adults . Arch Intern Med. 1988;;148:36-69.
21 +
Rifkin H, ed. Physician's Guide to Non—Insulin-Dependent (Type II) Diabetes: Diagnosis and Treatment . Alexandria, Va: American Diabetes Association Inc; 1988;.
22 +
Stern MP, Rosenthal M, Haffner SM, Hazuda HP, Franco LJ.  Sex difference in the effects of sociocultural status on diabetes and cardiovascular risk factors in Mexican Americans: the San Antonio Heart Study . Am J Epidemiol. 1984;;120:834-851.
23 +
Haffner SM, Stern MP, Hazuda HP, Pugh JA, Patterson JK.  Hyperinsulinemia in a population at high risk for non-insulin dependent diabetes mellitus . N Engl J Med. 1986;;315:220-224.
24 +
Haffner SM, Fong D, Stern MP, et al.  Diabetic retinopathy in Mexican Americans and non-Hispanic whites . Diabetes. 1988;;37:878-884.
25 +
Diehl AK, Stern MP.  Special health problems of Mexican Americans: obesity, gallbladder disease, diabetes mellitus, and cardiovascular disease . Adv Intern Med. 1989;;34:79-96.
26 +
Hazuda HP, Comeaux PJ, Stern MP, Haffner SM, Eifler CW, Rosenthal M.  A comparison of three indicators for identifying Mexican Americans in epidemiologic research: methodologic findings from the San Antonio Heart Study . Am J Epidemiol. 1986;;123:96-112.
27 +
National Diabetes Data Group.  Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance . Diabetes. 1979;;28:1039-1057.
28 +
Reaven GM.  Abnormal lipoprotein metabolism in non—insulin-dependent diabetes mellitus: pathogenesis and treatment . Am J Med. 1987;;83( (suppl 3A) ):31-40.
29 +
Schlesselman JJ. Case-Control Studies: Design, Conduct, Analysis. New York, NY: Oxford University Press Inc; 1982;:200-203.
30 +
Haffner SM, Rosenthal M, Hazuda HP, Stern MP, Franco LJ.  Evaluation of three potential screening tests for diabetes mellitus in a biethnic population . Diabetes Care. 1984;;7:347-353.
31 +
Bagdade JD, Porte D, Bierman EL.  Diabetic lipemia: form of acquired fat-induced lipemia . N Engl J Med. 1967;;276:427-433.
32 +
Weisweiler P, Drosner M, Schwandt P.  Dietary effects on very-low-density lipoproteins in type 2 (non—insulin-dependent) diabetes mellitus . Diabetologia. 1982;;23:101-103.
33 +
Kennedy L, Walshe K, Hadden DR, Weaver JA, Buchanan KD.  The effect of intensive dietary therapy on serum high density lipoprotein cholesterol in patients with type 2 (non—insulin-dependent) diabetes mellitus: a prospective study . Diabetologia. 1982;;23:24-27.
34 +
Taylor KG, John WG, Matthews KA, Wright AD.  A prospective study of the effect of 12 months treatment on serum lipids and apolipoproteins A-1 and B in type 2 (non—insulin-dependent) diabetes . Diabetologia. 1982;;23:507-510.
35 +
Liu GC, Coulston AM, Lardinois CK, Hollenbeck CB, Moore JG, Reaven GM.  Moderate weight loss and sulfonylurea treatment of non—insulin-dependent diabetes mellitus . Arch Intern Med. 1985;;145:665-669.
36 +
Paisey R, Elkeles RS, Hambley J, Magill PS.  The effects of chlopropamide and insulin on serum lipids, lipoproteins and fractional triglyceride removal . Diabetologia. 1978;;15:81-85.
37 +
Greenfield MS, Doberne L, Rosenthal M, Vreman HJ, Reaven GM.  Lipid metabolism in non—insulin-dependent diabetes mellitus: effect of glipizide therapy . Arch Intern Med. 1982;;142:1498-1500.
38 +
Taskinen M-R, Beltz WF, Harper I, et al.  Effects of NIDDM on very-low-density lipoprotein triglyceride and apolipoprotein B metabolism: studies before and after sulfonylurea therapy . Diabetes. 1986;;35:1268-1277.
39 +
Agardh C-D, Nilsson-Ehle P, Scherstén B.  Improvement of the plasma lipoprotein pattern after institution of insulin treatment in diabetes mellitus . Diabetes Care. 1982;;5:322-325.
40 +
Rabkin SW, Boyko E, Streja DA.  Changes in high density lipoprotein cholesterol after initiation of insulin therapy in non-insulin dependent diabetes mellitus: relationship to changes in body weight . Am J Med Sci. 1983;;285:14-20.
41 +
Hollenbeck CB, Chen Y-DI, Greenfield MS, Lardinois CK, Reaven GM.  Reduced plasma high density lipoprotein—cholesterol concentrations need not increase when hyperglycemia is controlled with insulin in noninsulin-dependent diabetes mellitus . J Clin Endocrinol Metab. 1986;;62:605-608.
42 +
Chen Y-DI, Jeng C-Y, Reaven GM.  HDL metabolism in diabetes . Diabetes Metab Rev. 1987;; 3:653-668.
43 +
Lopes-Virella MF, Colwell JA.  Pharmacological treatment of lipid disorders in diabetes mellitus . Diabetes Metab Rev. 1987;;3:691-722.
44 +
Diabetes Drafting Group.  Prevalence of small vessel and large vessel disease in diabetic patients from 14 centres: the World Health Organization multinational study of vascular disease in diabetics . Diabetologia. 1985;;28:615-640.
45 +
Klein R, Klein BEK, Moss SE, Davis MD, DeMets DL.  Glycosylated hemoglobin predicts the incidence and progression of diabetic retinopathy . JAMA. 1988;;260:2864-2871.
46 +
Herman JB, Medalie JH, Goldbourt U.  Differences in cardiovascular morbidity and mortality between previously known and newly diagnosed adult diabetics . Diabetologia. 1977;;13:229-234.
47 +
Fuller JH, Shipley MJ, Rose G, Jarrett RJ, Keen H.  Coronary heart disease risk and impaired glucose tolerance . Lancet. 1980;;1:1373-1376.
48 +
Yano K, Kagan A, McGee D, Rhoads GG.  Glucose intolerance and nine-year mortality in Japanese men in Hawaii . Am J Med. 1982;;72:71-80.
49 +
Jarrett RJ.  Type II (non—insulin-dependent) diabetes mellitus and coronary heart disease: chicken, egg or neither? Diabetologia. 1984;;26:99-102.
50 +
American Diabetes Association Consensus Panel.  Consensus statement on role of cardiovascular risk factors in the prevention and treatment of macrovascular disease in diabetes . Diabetes Care. In press.

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Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Blood Pressure Levels of Persons 6-74 Years: United States, 1971-74 . Washington, DC: National Center for Health Statistics; 1977;. US Dept of Health, Education, and Welfare publication (HRA) 78-1648. Vital and Health Statistics Series II, National Health Survey No. 203.
2 +
Shoenberger JA, Stamler J, Shekelle RB, Shekelle S.  Current status of hypertension control in an industrial population . JAMA. 1972;;222:559-562.
3 +
Wilber JA.  The problem of undetected and untreated hypertension in the community . Bull NY Acad Med. 1973;;49:510-520.
4 +
Veterans Administration Cooperative Study Group on Anthihypertensive Agents.  Effects of treatment on morbidity in hypertension: results in patients with diastolic blood pressure averaging 115 through 129 mm Hg . JAMA. 1967;;202:116-122.
5 +
Veterans Administration Cooperative Study Group on Antihypertensive Agents.  Effects of treatment on morbidity in hypertension, II: results in patients with diastolic blood pressure averaging 90 through 114 mm Hg . JAMA. 1970;;213:1143-1152.
6 +
Hypertension Detection and Follow-up Program Cooperative Group.  Five-year findings of the Hypertension Detection and Follow-up Program, I: reduction in mortality of persons with high blood pressure, including mild hypertension . JAMA. 1979;;242:2562-2571.
7 +
Stamler J, Stamler R, Riedlinger WF, Algera G, Roberts RH.  Hypertension screening of 1 million Americans: Community Hypertension Evaluation Clinic (CHEC) Program, 1973 through 1975 . JAMA. 1976;;235:2299-2306.
8 +
Hypertension Detection and Follow-up Program Cooperative Group.  Blood pressure studies in 14 communities: a two-stage screen for hypertension . JAMA. 1977;;237:2385-2391.
9 +
Borhani NO. Mortality Trend in Hypertension, United States, 1950-1976: Proceedings of the Conference on the Decline in Coronary Heart Disease Mortality . Washington, DC: US Dept of Health, Education, and Welfare; 1979;. National Institutes of Health publication 79-1610.
10 +
Franco LJ, Stern MP, Rosenthal M, Haffner SM, Hazuda HP, Comeaux PJ.  Prevalence, detection and control of hypertension in a biethnic community: the San Antonio Heart Study . Am J Epidemiol. 1985;;121:684-696.
11 +
Dayton S, Pearce ML, Hashimoto S, Dixon WJ, Tomiyasu U.  A controlled clinical trial of a diet high in unsaturated fat in preventing complications of atherosclerosis . Circulation. 1969;;40( (suppl 2) ): II-1-63.
12 +
Miettinen M, Turpeinen O, Karvonen MJ, Elosuo R, Paavilainen E.  Effect of cholesterol-lowering diet on mortality from coronary heart disease and other causes: a twelve-year clinical trial in men and women . Lancet. 1972;;2:835-838.
13 +
Lipid Research Clinics Program.  The Lipid Research Clinics Coronary Primary Prevention Trial results, I: reduction in incidence of coronary heart disease . JAMA. 1984;;251:351-364.
14 +
Hjermann I, Velve Byre K, Holme I, Leren P.  Effect of diet and smoking intervention on the incidence of coronary heart disease: report from the Oslo Study Group of a randomized trial in healthy men . Lancet. 1981;;2:1303-1310.
15 +
The Coronary Drug Project Research Group.  Clofibrate and niacin in coronary heart disease . JAMA. 1975;;231:360-381.
16 +
Canner PL, Berge KG, The Coronary Drug Project Research Group, et al.  Fifteen year mortality in Coronary Drug Project patients: long-term benefit with niacin . J Am Coll Cardiol. 1986;; 8:1245-1255.
17 +
Frick MH, Elo O, Haapa K, et al.  Helsinki Heart Study: primary prevention trial with gemfibrozil in middle-aged men with dyslipidemia. Safety of treatment, changes in risk factors, and incidence of coronary heart disease . N Engl J Med. 1987;;317:1237-1245.
18 +
Blankenhorn DH, Nessim SA, Johnson RL, Sanmarco ME, Azen SP, Cashin-Hemphill L.  Beneficial effects of combined colestipol-niacin therapy on coronary atherosclerosis and coronary venous bypass grafts . JAMA. 1987;;257:3233-3240.
19 +
Pugh JA, Stern MP, Haffner SM, Hazuda HP, Patterson JK.  Detection and treatment of hypercholesterolemia in a biethnic community, 1979-85 . J Gen Intern Med. 1988;;3:331-336.
20 +
 The Expert Panel. Report of the National Cholesterol Education Program expert panel on detection, evaluation, and treatment of high blood cholesterol in adults . Arch Intern Med. 1988;;148:36-69.
21 +
Rifkin H, ed. Physician's Guide to Non—Insulin-Dependent (Type II) Diabetes: Diagnosis and Treatment . Alexandria, Va: American Diabetes Association Inc; 1988;.
22 +
Stern MP, Rosenthal M, Haffner SM, Hazuda HP, Franco LJ.  Sex difference in the effects of sociocultural status on diabetes and cardiovascular risk factors in Mexican Americans: the San Antonio Heart Study . Am J Epidemiol. 1984;;120:834-851.
23 +
Haffner SM, Stern MP, Hazuda HP, Pugh JA, Patterson JK.  Hyperinsulinemia in a population at high risk for non-insulin dependent diabetes mellitus . N Engl J Med. 1986;;315:220-224.
24 +
Haffner SM, Fong D, Stern MP, et al.  Diabetic retinopathy in Mexican Americans and non-Hispanic whites . Diabetes. 1988;;37:878-884.
25 +
Diehl AK, Stern MP.  Special health problems of Mexican Americans: obesity, gallbladder disease, diabetes mellitus, and cardiovascular disease . Adv Intern Med. 1989;;34:79-96.
26 +
Hazuda HP, Comeaux PJ, Stern MP, Haffner SM, Eifler CW, Rosenthal M.  A comparison of three indicators for identifying Mexican Americans in epidemiologic research: methodologic findings from the San Antonio Heart Study . Am J Epidemiol. 1986;;123:96-112.
27 +
National Diabetes Data Group.  Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance . Diabetes. 1979;;28:1039-1057.
28 +
Reaven GM.  Abnormal lipoprotein metabolism in non—insulin-dependent diabetes mellitus: pathogenesis and treatment . Am J Med. 1987;;83( (suppl 3A) ):31-40.
29 +
Schlesselman JJ. Case-Control Studies: Design, Conduct, Analysis. New York, NY: Oxford University Press Inc; 1982;:200-203.
30 +
Haffner SM, Rosenthal M, Hazuda HP, Stern MP, Franco LJ.  Evaluation of three potential screening tests for diabetes mellitus in a biethnic population . Diabetes Care. 1984;;7:347-353.
31 +
Bagdade JD, Porte D, Bierman EL.  Diabetic lipemia: form of acquired fat-induced lipemia . N Engl J Med. 1967;;276:427-433.
32 +
Weisweiler P, Drosner M, Schwandt P.  Dietary effects on very-low-density lipoproteins in type 2 (non—insulin-dependent) diabetes mellitus . Diabetologia. 1982;;23:101-103.
33 +
Kennedy L, Walshe K, Hadden DR, Weaver JA, Buchanan KD.  The effect of intensive dietary therapy on serum high density lipoprotein cholesterol in patients with type 2 (non—insulin-dependent) diabetes mellitus: a prospective study . Diabetologia. 1982;;23:24-27.
34 +
Taylor KG, John WG, Matthews KA, Wright AD.  A prospective study of the effect of 12 months treatment on serum lipids and apolipoproteins A-1 and B in type 2 (non—insulin-dependent) diabetes . Diabetologia. 1982;;23:507-510.
35 +
Liu GC, Coulston AM, Lardinois CK, Hollenbeck CB, Moore JG, Reaven GM.  Moderate weight loss and sulfonylurea treatment of non—insulin-dependent diabetes mellitus . Arch Intern Med. 1985;;145:665-669.
36 +
Paisey R, Elkeles RS, Hambley J, Magill PS.  The effects of chlopropamide and insulin on serum lipids, lipoproteins and fractional triglyceride removal . Diabetologia. 1978;;15:81-85.
37 +
Greenfield MS, Doberne L, Rosenthal M, Vreman HJ, Reaven GM.  Lipid metabolism in non—insulin-dependent diabetes mellitus: effect of glipizide therapy . Arch Intern Med. 1982;;142:1498-1500.
38 +
Taskinen M-R, Beltz WF, Harper I, et al.  Effects of NIDDM on very-low-density lipoprotein triglyceride and apolipoprotein B metabolism: studies before and after sulfonylurea therapy . Diabetes. 1986;;35:1268-1277.
39 +
Agardh C-D, Nilsson-Ehle P, Scherstén B.  Improvement of the plasma lipoprotein pattern after institution of insulin treatment in diabetes mellitus . Diabetes Care. 1982;;5:322-325.
40 +
Rabkin SW, Boyko E, Streja DA.  Changes in high density lipoprotein cholesterol after initiation of insulin therapy in non-insulin dependent diabetes mellitus: relationship to changes in body weight . Am J Med Sci. 1983;;285:14-20.
41 +
Hollenbeck CB, Chen Y-DI, Greenfield MS, Lardinois CK, Reaven GM.  Reduced plasma high density lipoprotein—cholesterol concentrations need not increase when hyperglycemia is controlled with insulin in noninsulin-dependent diabetes mellitus . J Clin Endocrinol Metab. 1986;;62:605-608.
42 +
Chen Y-DI, Jeng C-Y, Reaven GM.  HDL metabolism in diabetes . Diabetes Metab Rev. 1987;; 3:653-668.
43 +
Lopes-Virella MF, Colwell JA.  Pharmacological treatment of lipid disorders in diabetes mellitus . Diabetes Metab Rev. 1987;;3:691-722.
44 +
Diabetes Drafting Group.  Prevalence of small vessel and large vessel disease in diabetic patients from 14 centres: the World Health Organization multinational study of vascular disease in diabetics . Diabetologia. 1985;;28:615-640.
45 +
Klein R, Klein BEK, Moss SE, Davis MD, DeMets DL.  Glycosylated hemoglobin predicts the incidence and progression of diabetic retinopathy . JAMA. 1988;;260:2864-2871.
46 +
Herman JB, Medalie JH, Goldbourt U.  Differences in cardiovascular morbidity and mortality between previously known and newly diagnosed adult diabetics . Diabetologia. 1977;;13:229-234.
47 +
Fuller JH, Shipley MJ, Rose G, Jarrett RJ, Keen H.  Coronary heart disease risk and impaired glucose tolerance . Lancet. 1980;;1:1373-1376.
48 +
Yano K, Kagan A, McGee D, Rhoads GG.  Glucose intolerance and nine-year mortality in Japanese men in Hawaii . Am J Med. 1982;;72:71-80.
49 +
Jarrett RJ.  Type II (non—insulin-dependent) diabetes mellitus and coronary heart disease: chicken, egg or neither? Diabetologia. 1984;;26:99-102.
50 +
American Diabetes Association Consensus Panel.  Consensus statement on role of cardiovascular risk factors in the prevention and treatment of macrovascular disease in diabetes . Diabetes Care. In press.

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