Abstract #1384613: Statin Utilization Among Patients with Type 2 Diabetes with and Without Cardiovascular Disease

Abstract

Both American Diabetes Association (ADA) and American College of Cardiology (ACC) guidelines recommend that patients with diabetes between the ages of 40-75 years be prescribed at least a moderate-intensity statin. In all patients with diabetes who have established atherosclerotic cardiovascular disease (CVD), a high-intensity statin should be implemented as a secondary prevention measure. The purpose of this study was to assess the prescribing patterns of statin therapy in patients with type 2 diabetes (T2D) with and without established CVD in our large integrated delivery system. A retrospective cohort study was conducted using the enterprise-wide electronic health record (EHR) system at Cleveland Clinic to identify statin utilization among patients with T2D with and without CVD. A total of 74,949 patients were identified, 30,848 with established CVD, and 44,101 without. Among patients with and without established CVD, the mean age was 67 years and 62 years, 58% and 49% male, 73% and 72% white, 14% and 12% current smoker, median BMI 32 kg/m2 and 33 kg/m2, median eGFR 62 mL/min and 78 mL/min, and median A1c 6.9% and 6.9%, and median LDL 74 mg/dL and 84 mg/dL, respectively. Among patients with T2D without CVD, the rate of statin prescription at our institution was 60.4%, with 94% of those patients receiving at least a moderate-intensity statin (6.0% low-intensity, 59.1% moderate-intensity, 34.9% high-intensity). In patients with T2D and established CVD, the rate of statin prescription was 82.0%, with 59.3% receiving a high-intensity statin (3.7% low-intensity, 37% moderate-intensity). At our institution, only 60.4% of patients with T2D were prescribed statin therapy for primary prevention. However, among those, 94.0% were prescribed either a moderate- or high-intensity statin. While 82.0% of individuals with T2D and established CVD were prescribed a statin, only 59.3% were receiving high-intensity. These results have identified opportunities for improvement, including increasing the number of patients with T2D being prescribed at least moderate-intensity statin therapy for primary prevention, and ensuring that those being treated for secondary prevention are receiving high-intensity statin.