The natural history of LDL control in type 2 diabetes: a prospective study of adherence to lipid guidelines.

D espite randomized trials repeatedly showing the benefits of lowering LDL cholesterol with hydroxymethylglutaryl (HMG)-CoA reductase inhibitors (statins) (1–3), these medications are suboptimally used in type 2 diabetes (4–10). Although this care gap in type 2 diabetes has been frequently described in cross-sectional studies (6–11), it may be as informative to understand LDL control over time. In particular, there is growing recognition of care gaps in diabetes when comparing urban and academic settings with rural settings (11,12). Therefore, we examined changes over an 18-month period for adherence to guidelinerecommended LDL cholesterol targets in a rural cohort with type 2 diabetes and determined the rates and correlates of 1) losing control of LDL cholesterol in those who were initially at target and 2) achieving control of LDL cholesterol in those who were not initially at target.