Diabetes research and clinical practice · 2026
Optimising lipid monitoring interval for primary prevention of cardiovascular disease in patients with type-2 diabetes: A target trial emulation study.
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Wang Boyuan, Tse Emily Tsui Yee, Chui Celine Sze Ling, Lam Cindy Lo Kuen, Wan Eric Yuk Fai
Аннотация
BACKGROUND: Guidelines differ on how often to monitor lipid profiles in adults with type 2 diabetes mellitus (T2DM) without established cardiovascular disease (CVD), and randomized evidence is lacking. This study aimed to optimise lipid monitoring intervals for type-2 diabetes mellitus (T2DM) patients at various LDL-C levels.
METHODS: This is a target trial emulation study using territory-wide electronic health records from the Hong Kong Hospital Authority. Adults with T2DM and no prior CVD who had ≥2 lipid panel tests within any 12‑month window during 2009-2012 were enrolled. The index date was the date of the second lipid test. Participants were stratified by baseline LDL‑C (<1.8, 1.8-2.59, ≥2.6 mmol/L). Within each LDL‑C stratum, we emulated a three-arm target trial using a clone-censor-weight (CCW) approach to compare three monitoring strategies: monitoring lipid panels every (1) 2-8 months, (2) 9-15 months, or (3) 16-24 months. Pooled logistic regression was used to estimate hazard ratios (HRs) for all‑cause mortality and major CVD associated with each monitoring strategy. Follow‑up continued until the first occurrence of an outcome, death, or 31 December 2021.
RESULTS: For LDL-C < 1.8 mmol/L, extending monitoring intervals to 16-24 months were not associated with higher risks of mortality or CVD risk compared to 2-8 months (HR [95% CI]: mortality: 1.094 [0.948, 1.263]; CVD: 1.002 [0.846, 1.187]). For the group with LDL-C levels of 1.8-2.59 mmol/L, monitoring of the lipid profile every 16-24 months was associated with higher mortality risk compared to monitoring every 2-8 months (HR [95% CI]: 1.154 [1.069, 1.245]). For LDL-C ≥ 2.6 mmol/L, monitoring every 9-15 months was associated with higher risks of mortality and CVD compared to 2-8 months (HR [95% CI]: mortality: 1.263 [1.174, 1.359]; CVD: 1.060 [1.017, 1.105]).
CONCLUSIONS: Lipid monitoring frequency in T2DM may be individualized by baseline LDL‑C level, with intervals of approximately 16-24, 9-15, and 2-8 months representing minimum frequencies.
METHODS: This is a target trial emulation study using territory-wide electronic health records from the Hong Kong Hospital Authority. Adults with T2DM and no prior CVD who had ≥2 lipid panel tests within any 12‑month window during 2009-2012 were enrolled. The index date was the date of the second lipid test. Participants were stratified by baseline LDL‑C (<1.8, 1.8-2.59, ≥2.6 mmol/L). Within each LDL‑C stratum, we emulated a three-arm target trial using a clone-censor-weight (CCW) approach to compare three monitoring strategies: monitoring lipid panels every (1) 2-8 months, (2) 9-15 months, or (3) 16-24 months. Pooled logistic regression was used to estimate hazard ratios (HRs) for all‑cause mortality and major CVD associated with each monitoring strategy. Follow‑up continued until the first occurrence of an outcome, death, or 31 December 2021.
RESULTS: For LDL-C < 1.8 mmol/L, extending monitoring intervals to 16-24 months were not associated with higher risks of mortality or CVD risk compared to 2-8 months (HR [95% CI]: mortality: 1.094 [0.948, 1.263]; CVD: 1.002 [0.846, 1.187]). For the group with LDL-C levels of 1.8-2.59 mmol/L, monitoring of the lipid profile every 16-24 months was associated with higher mortality risk compared to monitoring every 2-8 months (HR [95% CI]: 1.154 [1.069, 1.245]). For LDL-C ≥ 2.6 mmol/L, monitoring every 9-15 months was associated with higher risks of mortality and CVD compared to 2-8 months (HR [95% CI]: mortality: 1.263 [1.174, 1.359]; CVD: 1.060 [1.017, 1.105]).
CONCLUSIONS: Lipid monitoring frequency in T2DM may be individualized by baseline LDL‑C level, with intervals of approximately 16-24, 9-15, and 2-8 months representing minimum frequencies.