Abstract 298: Fibrate use in patients with type 2 diabetes

Abstract

Diabetes mellitus is considered to be a coronary heart disease (CHD) equivalent, with heart disease and stroke accounting for the majority of diabetes-related deaths. As a result, patients with diabetes require aggressive treatment of CHD risk factors, including dyslipidemia. In addition to targeted reduction of LDL cholesterol, current guidelines recommend addition of a fibrate (gemfibrozil, fenofibrate, or clofibrate) in patients with established CHD and atherogenic dyslipidemia: triglycerides (TG) 200-499 mg/dL and HDL cholesterol (HDL-C) ≤40 mg/dL. Fibrates have also been recommended for patients with TG ≥500 mg/dL to reduce risk of acute pancreatitis. Yet, data supporting the use of fibrates in these settings remains variable and inconclusive. We therefore sought to provide an in-depth analysis of patterns of fibrate use among patients with type 2 diabetes between 2001 and 2010. Using Ingenix administrative claims, we identified 71,161 patients age ≥18 years old with an established diagnosis of type 2 diabetes (ICD-9 250.XX) and ≥3 years of continuous enrollment who were newly initiated on a fibrate between 2001 and 2010. Lab results were available for a subset of 18,863 (26.5%) patients, who were included in final analysis. During each 2-year period, between 77.6% - 84.1% of patients had a lipid test performed within the preceding 12 months (p=0.59 for change in testing over time). The prevalence of atherogenic dyslipidemia increased over time, from 20.8% (2001-2002) to 41.2% (2009-2010); 4.84% rise per 2-year period (p=0.002). The prevalence of severe atherogenic dyslipidemia (HDL-C ≤40 mg/dL and TG ≥500 mg/dL), also increased over time, from 9.3% in 2001-2002 to 13.6% in 2009-2010; 1.17% rise per 2-year period (p=0.002). In contrast, percent of patients with TG ≥500 mg/dL decreased over time, from 20.5% in 2001-2002 to 16.7% in 2009-2010; 1.19% decline per 2-year period (p=0.03). Initiation of new fibrate therapy in treatment naïve patients with diabetes remained constant; 2.0% in 2001-2002 and 1.6% in 2009-2010 (p=0.93). Subgroup analysis of patients with atherogenic dyslipidemia also showed no significant change in fibrate initiation over time; 11.4% in 2001-2002 and 15.7% in 2009-2010 (p=0.3). Similarly, while there was a trend toward increased initiation of fibrates among patients with TG ≥500 mg/dL, this trend was not statistically significant (27.4% in 2001-2002 and 41.6% in 2009-2010; 3.34% change per 2-year period (p=0.09)). In conclusion, the prevalence of atherogenic dyslipidemia among patients with type 2 diabetes has increased significantly over the past decade. However, fibrate use in all patients with type 2 diabetes, including those specifically with atherogenic dyslipidemia, has remained constant throughout the observation period, despite lack of conclusive evidence supporting its use.