ME1 - Utilization Patterns of Lipid-Lowering Medications In High Risk Diabetic Patients

Abstract

Risk of cardiovascular events risk accounts for major morbidity and mortality in patients with diabetes. The revised 2015 American Diabetes Association (ADA) guidelines recommend statin therapy in general for diabetic patients between 40-75 years of age. However, high-intensity statins are recommended for those with either CVD risk factors or overt CVD and moderate-intensity statins for those with no additional risk factors. Limited baseline data exists regarding the extent of statin use in high risk diabetic patients. Hence, the objective of this study was to analyze the extent of statin medication use in high risk diabetic patients based on the ADA guidelines. This study involved analyses of visits by patients aged 40-75 years with diabetes and atherosclerotic cardiovascular disease (ASCVD) or cardiovascular risk factors (CVD) in office-based settings using 2010 public use data files of the National Ambulatory Medical Care Survey (NAMCS). High and moderate intensity statins from the ADA 2015 guidelines were used to identify statin medications in the visits. Descriptive analysis was conducted using sampling weights to determine the prevalence of visits involving statin medications. In 2010, 113 million(11.23%) office visits were made for diabetes; either ASCVD or CVD was a risk factor in 91 million(81%) visits. Statin therapy was prescribed in 45.1% (CI: 37-53) of the diabetic visits with ASCVD and 39.9% (CI: 35-44) visits with CVD Risk. Multivariable analyses revealed that statins were associated with hyperlipidemia (OR: 0.49 (CI: 0.25-0.97)) and the physician specialty, where cardiovascular (OR: 3.9 (CI: 1.9-8.2)), internal medicine (OR: 7.6 (CI: 2.8-20.2)) and general (OR: 2.9 (CI: 1.2-6.8)) physicians were associated with greater odds of prescribing statins. Less than half of visits by diabetic patients with ASCVD or CVD risk involved statin therapy. There is significant scope to improve quality of care in high risk diabetes patients.