Comparison of Optimal Cardiovascular Risk Factor Management in Patients with Type 2 Diabetes Who Attended Urban Medical Health Center with those Attended a Tertiary Care Center: Experiences from Tehran, Iran

Abstract

Background: Diabetes is a leading cause of cardiovascular disease (CVD). Moreover, CVD
accounts for primary cause of death among diabetic patients. Physicians, especially in the primary
care setting, have effective role in the management of cardiovascular risk factors. Therefore,
we aimed to compare the prevalence of modifiable cardiovascular risk factors in Type 2 diabetic
patients attending to an urban health center as a primary care center with Institute of Endocrinology
and Metabolism Diabetes Clinic (IEMDC) as a tertiary center.

Methods: This cross‑sectional study was performed on 200 adult diabetic patients attending urban
health center (Abouzar Health Center) and 201 diabetic patients in a tertiary center. The patients’
cardiovascular risk factors including lipid profile, systolic and diastolic blood pressure (BP), and
smoking history were recorded. The number of patients who did not achieve the target according
to the American Diabetes Association guidelines was determined and compared.

Results: The patients in urban health center were older than those who attending IEMDC (P = 0.004).
The duration of diabetes was longer among urban center patients (P < 0.001). Comparison of
cardiovascular risk factors between two groups of patients showed a significant number of
patients with poor‑controlled low‑density lipoprotein (75% vs. 44.7%) and triglyceride (74% vs.
51.7%) in patients attending primary center (P < 0.001). However, the prevalence of high diastolic
BP (60.6% vs. 44.5%) was significantly higher in patients attending IEMDC (P = 0.001). There
was no significant difference between the two centers’ findings in glycosylated hemoglobin level,
high‑density lipoprotein level, and systolic BP.

Conclusions: Both centers have failure in target achievement in some risk factors; however, the
inability of the primary care center in controlling hyperlipidemia in comparison with the tertiary
center is a serious warning to provide training about managing dyslipidemia in these centers.

Keywords: Cardiovascular risk factors, primary care setting, tertiary care setting, Type 2 diabetes