Abstract
BackgroundManagement of type 2 diabetes mellitus (T2DM) encompasses intensive glycaemic control, along with treatment of comorbidities and complications to handle the increased risk of cardiovascular disease (CVD). Improved control of LDL-cholesterol (LDL-C) with lipid-lowering medications is associated with reduced CVD risk in T2DM patients. Thus, treatment guidelines recommend lipid-lowering medications for T2DM patients with LDL-C above risk-associated thresholds. This study aimed to assess healthcare provider adherence to guidelines regarding lipid-lowering medication prescription among T2DM patients and to analyse factors associated with lipid-lowering medication prescription.MethodsObservations in 2007 − 2014 for T2DM patients age ≥ 18 were collected from the Swedish National Diabetes Register. Observations were excluded if they lacked information about LDL-C, lipid-lowering medication prescription or CVD. Observations with established CVD were attributed to secondary prevention; remaining observations were attributed to primary prevention. The analyses included primary and secondary prevention observations with LDL-C above risk-associated thresholds (LDL-C ≥ 2.5 mmol/l and LDL-C ≥ 1.8 mmol/l respectively). Guideline adherence was analysed as the probability of prescribing lipid-lowering medications using mixed-effect model regression adjusted for potential confounders. Factors associated with prescribing lipid-lowering medications were analysed for patient and healthcare provider characteristics using mixed-effect model regression and odds ratio.ResultsA total of 1,204,376 observations from 322,046 patients reported by 1352 healthcare providers were included. Primary prevention accounted for 63%; 52% were men, mean age was 64 and mean LDL-C was 3.4 mmol/l. For secondary prevention, 60% were men, mean age was 72 and mean LDL-C was 2.7 mmol/l. During 2007–2014, guideline adherence ranged from 36 to 47% for primary prevention and 59 to 69% for secondary prevention. In general, concomitant prescription of diabetes medications, antiplatelets and antihypertensives along with smoking and specialised care were associated with higher prescription of lipid-lowering medications. Patients age ≥ 80 were associated with lower prescription of lipid-lowering medications. Higher prescription was associated with longer diabetes duration in primary prevention and men in secondary prevention.ConclusionsAdherence to treatment guidelines levelled off after an initial increase in both prevention groups. Lipid-lowering medication prescription was based on individualised CVD risk.
Highlights
Management of type 2 diabetes mellitus (T2DM) encompasses intensive glycaemic control, along with treatment of comorbidities and complications to handle the increased risk of cardiovascular disease (CVD)
Lipidlowering medication prescription was based on individualised CVD risk
In this nationwide study of more than 300,000 T2DM patients, prescription of lipid-lowering medications was found in half of the observations attributed to primary prevention and three-quarters of the observations attributed to secondary prevention in 2007-2014
Summary
Management of type 2 diabetes mellitus (T2DM) encompasses intensive glycaemic control, along with treatment of comorbidities and complications to handle the increased risk of cardiovascular disease (CVD). Treatment guidelines recommend lipid-lowering medications for T2DM patients with LDL-C above risk-associated thresholds. Management of type 2 diabetes mellitus (T2DM) includes intensive glycaemic control, along with treatment of comorbidities and complications to combat the increased risk of cardiovascular disease (CVD) [1,2,3]. Improved control of low-density lipoprotein cholesterol (LDL-C) with lipid-lowering medications is associated with reduced risk of CVD and mortality in patients with T2DM [4,5,6]. International treatment guidelines recommend lipid-lowering medications for T2DM patients with an LDL-C above risk-associated thresholds until 2015 [7,8,9,10]. For T2DM patients with established CVD, the European Society of Cardiology and later the International Diabetes Federation and the American Diabetes Association recommended lipid-lowering medications to reduce LDL-C below 1.8 mmol/l [1, 3, 12]
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