Cardiovascular risk factors and metabolic control in type 2 diabetic subjects attending outpatient clinics in Italy: the SFIDA (survey of risk factors in Italian diabetic subjects by AMD) study

Abstract

Background and aim: To perform an observational, cross-sectional study aiming to assess multiple cardiovascular risk factors and metabolic control in a very large and representative sample of type 2 diabetic subjects attending diabetes outpatient clinics (DOCs) in Italy.

Methods and results: Two hundred and sixty-one clinics were involved, representing about one-third of the whole number of DOCs in the Country. Each clinic recruited on a random basis from 50 to 100 type 2 diabetic patients aged 35-70 years, diagnosed more than six months before the start of the study. Demographic and clinical data were collected and blood pressure, lipids, HbA(1c), fasting blood glucose (FBG), and microalbuminuria were measured. Overall, 12,222 type 2 diabetic patients were recruited in 253 DOCs. Female subjects showed higher FBG, HbA 1c, blood pressure, lipid levels, and a longer duration of disease. The proportion of patients with BMI > or = 30 was 33.3% among males and 45.9% among females; 40.9% of male patients had a waist circumference greater than 102 cm, while 79% of female patients had a waist circumference over 88 cm. More than two-third of the patients (74.4%) had systolic blood pressure values of > or = 130 mmHg, and one-third (33.2%) had diastolic values > or = 85 mmHg. The mean value of HbA(1c) was 7.6+/-1.6, and 23.7% of the observed population had an HbA 1c level > 8.5%. More than half of the study population had total cholesterol levels > or = 5.2 mmol/l, 47% had LDL cholesterol values of 3.3 mmol/l or greater and 9.6% had HDL cholesterol level lower than 0.90 mmol/l. The presence of multiple lipid alterations was associated with markedly higher HbA 1c levels, in both subjects treated with lipid lowering drugs and untreated subjects. Finally, even moderate increases in HbA 1c levels (i.e. HbA 1c > 7.5%) were associated with a statistically significant greater risk of systolic blood pressure levels > or = 160 mmHg in women (OR = 1.40; 95% CI 1.09-1.80) but not in men (OR = 1.21; 95% CI 0.96-1.54).

Conclusions: The SFIDA study provides a clear indication of the need to orient diabetes care towards the control of global cardiovascular risk. Only a stricter adherence to the existing guidelines and a much stronger attention to the attainment of the desired therapeutic goals will allow a decrease in morbidity and mortality as well as in the costs related to diabetes.