GUIDELINE-DIRECTED LIPID GOAL ATTAINMENT IN PATIENTS WITH DIABETES AT HIGH AND VERY HIGH CARDIOVASCULAR RISK: REAL-WORLD EVIDENCE OF A PROFOUND TREATMENT GAP

Öz

Objective: To evaluate lipid-lowering therapy patterns and the attainment of guideline-directed low-density lipoprotein cholesterol (LDL-C) and non-high-density lipoprotein cholesterol (non-HDL-C) goals among high and very high-risk patients with diabetes mellitus in a real-world clinical setting. 
Material and Methods: This retrospective observational study included 202 patients (197 with type 2 and 5 with type 1 diabetes mellitus). Patients were stratified into high-risk (HR, n=132) and very high-risk (VHR, n=70) categories according to cardiovascular risk criteria. Statin utilization, combination therapy rates, and target attainment frequencies (LDL-C <70 mg/dL for HR; <55 mg/dL for VHR) were analyzed based on current European guidelines. 
Results: Only 51.0% of the total cohort received statin therapy (50.0% in HR and 52.9% in VHR groups). Combination therapy was exceptionally rare (0 .5%, n= 1). LD L-C target attainment was ala rmingly low; merely 18.2% of HR patients a nd 1 0.0% o f V HR patients achieved th eir sp ecific goa ls. Amo ng patients actively treated with statins, attainment rates remained highly inadequate (19.7% in HR and 10.8% in VHR). Non-HDL-C goals were successfully reached by only 16.7% of HR and 11.4% of VHR patients. 
Conclusion:  Guideline-directed lipid goal attainment i s critically suboptimal amo ng hig h and very high-risk diabetic patients. This profound treatment gap, likely driven by a complex interplay of physician-level therapeutic inertia and patient-level non-adherence or reluctance, highlights an urgent need for proactive, patient-centered, and protocol-driven lipid management.

Anahtar Kelimeler

• Diabetes Mellitus
• Dyslipidemias
• Cholesterol
• LDL
• Treatment Outcome
• Guideline Adherence

Destekleyen Kurum

Funding: The author received no financial support for the research, authorship, and/or publication of this article.

Etik Beyan

The study protocol was reviewed and approved by the Non-Invasive Clinical Research Ethics Committee of Yozgat Bozok University (decision date: 18.02.2026 number: 2026-GOKAEK-264_2026.02.18_27). The study was conducted in accordance with the principles of the Declaration of Helsinki. Informed Consent: Due to the retrospective nature of the study, the requirement for informed consent was waived by the ethics committee

Yüksek ve Çok Yüksek Kardiyovasküler Risk Taşıyan Diyabet Hastalarında Kılavuzların Önerdiği Lipid Hedeflerine Ulaşma: Ciddi Bir Tedavi Açığına Dair Gerçek Hayattan Kanıtlar

Öz

Amaç: Yüksek ve çok yüksek kardiyovasküler riskli diyabet hastalarında lipit düşürücü tedavi kullanım kalıplarını ve kılavuzların önerdiği düşük yoğunluklu lipoprotein kolesterol (LDL-K) ile non-yüksek dansiteli lipoprotein kolesterol (non-HDL-K) hedeflerine ulaşma oranlarını gerçek yaşam verileriyle değerlendirmektir. 
Gereç ve Yöntemler: Bu retrospektif gözlemsel çalışmaya 202 diyabet hastası dahil edilmiştir. Hastalar kardiyovasküler risk kriterlerine göre yüksek riskli (YR, n=132) ve çok yüksek riskli (ÇYR, n=70) olarak iki kategoriye ayrılmıştır. Statin kullanımı, kombinasyon tedavi oranları ve güncel Avrupa kılavuzlarına dayalı hedeflere ulaşma sıklıkları ayrıntılı olarak analiz edilmiştir. 
Bulgular:  Tüm kohortun yalnızca %51,0'i statin tedavisi almaktaydı (YR %50,0, ÇYR %52,9). Kombinasyon tedavisi kullanımı istisnai derecede nadirdi (%0,5). Genel LDL-K hedefine ulaşma oranları endişe verici derecede düşüktü; YR hastalarının %18,2'si, ÇYR hastalarının ise sadece %10,0'u hedeflerine ulaştı. Statin tedavisi alan hastalar arasında dahi hedefe ulaşma oranları oldukça yetersiz kalmıştır (YR'de %19,7 ve ÇYR'de %10,8). Non-HDL-K hedeflerine ise YR hastalarının %16,7'si, ÇYR hastalarının %11,4'ü ulaşabilmiştir. Sonuç: Yüksek ve çok yüksek riskli diyabet hastalarında kılavuzların önerdiği lipit hedeflerine ulaşma oranları kritik derecede düşüktür. Muhtemelen hekim kaynaklı klinik atalet ile hasta uyumsuzluğu veya tedavi reddinin karmaşık etkileşiminden kaynaklanan bu derin tedavi boşluğu, proaktif, hasta odaklı ve protokole dayalı lipit yönetimine acil ihtiyaç duyulduğunu vurgulamaktadır.
 

Anahtar Kelimeler

• Diabetes Mellitus
• Dislipidemiler
• Kolesterol
• LDL
• Tedavi Sonucu
• Kılavuza Uyum

Destekleyen Kurum

Yazar, bu makalenin araştırılması, yazılması ve/veya yayınlanması için herhangi bir mali destek almamıştır.

Etik Beyan

The study protocol was reviewed and approved by the Non-Invasive Clinical Research Ethics Committee of Yozgat Bozok University (decision date: 18.02.2026 number: 2026-GOKAEK-264_2026.02.18_27). The study was conducted in accordance with the principles of the Declaration of Helsinki.

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