Abstract
ObjectiveTo assess the trends in cardiovascular risk factor control and drug therapy from 2007 to 2018 in subjects with type 2 diabetes mellitus (T2DM).Materials and MethodsCross-sectional analysis using yearly clinical data and treatment obtained from the SIDIAP database. Patients aged ≥18 years with a diagnosis of T2DM seen in primary care in Catalonia, Spain. ResultsThe number of T2DM patients increased from 299,855 in 2007 to 394,266 in 2018. We also found an increasing prevalence of cardiovascular disease, heart failure, and chronic kidney disease (from 18.4 to 24.4%, from 4.5 to 7.3%, and from 20.2 to 31.3%, respectively). The achievement of glycemic targets (HbA1c<7%) scarcely changed (54.9% to 55.9%). Major improvements were seen in blood pressure (≤140/90 mmHg: from 55% to 71.8%), and in lipid control (low-density lipoprotein cholesterol <100 mg/dl: 33.4% to 48.4%), especially in people with established cardiovascular disease (48.8 to 69.7%). Simultaneous achievement of all three targets improved from 12.5% to 20.1% in the overall population and from 24.5% to 32.2% in those with cardiovascular disease but plateaued after 2013. There was an increase in the percentage of patients treated with any antidiabetic drug (70.1% to 81.0%), especially metformin (47.7% to 67.7%), and DPP4i (0 to 22.6%). The use of SGLT-2 and GLP-1ra increased over the years, but remained very low in 2018 (5.5% and 2.1% of subjects, respectively). There were also relevant increases in the use of statins (38.0% to 49.2%), renin-angiotensin system (RAS) drugs (52.5% to 57.2%), and beta-blockers (14.3% to 22.7%).ConclusionsDuring the 2007-2018 period, relevant improvements in blood pressure and lipid control occurred, especially in people with cardiovascular disease. Despite the increase in the use of antidiabetic and cardiovascular drugs, the proportion of patients in which the three objectives were simultaneously achieved is still insufficient and plateaued after 2013. The use of antidiabetic drugs with demonstrated cardio renal benefits (SGLT-2 and GLP-1ra) increased over the years, but their use remained quite low.
Highlights
Type 2 diabetes mellitus (T2DM) is a global health problem due to its high worldwide prevalence, high cost of management, associated chronic complications, disability, and premature deaths [1]
Previous studies reported that achievement of the three diabetes treatment goals had improved from the late 1990s to 2018 in the United States (US) [8,9,10], mainly from 1999 to 2010 [8], but recent analyses suggest that progress may have stalled or reversed in later periods [9, 10]
A study in the United Kingdom (UK) showed that control of cardiovascular risk factors (CVRFs) remained suboptimal among both sexes [11], while another study reported that CVRFs had worsened especially among the overweight and obese adults [12]
Summary
Type 2 diabetes mellitus (T2DM) is a global health problem due to its high worldwide prevalence, high cost of management, associated chronic complications, disability, and premature deaths [1]. Blood pressure, and lipid control lower the risk of diabetes-related complications and death, especially when attained concomitantly. There has been consensus regarding several major goals of diabetes treatment for over two decades: achieving treatment targets for hemoglobin A1c (HbA1c) levels, blood pressure (BP), and low-density lipoprotein cholesterol (LDL-C) levels, as well as promoting smoking cessation [2,3,4,5,6,7]. Previous studies reported that achievement of the three diabetes treatment goals had improved from the late 1990s to 2018 in the United States (US) [8,9,10], mainly from 1999 to 2010 [8], but recent analyses suggest that progress may have stalled or reversed in later periods [9, 10]. A study in the United Kingdom (UK) showed that control of cardiovascular risk factors (CVRFs) remained suboptimal among both sexes [11], while another study reported that CVRFs had worsened especially among the overweight and obese adults [12]
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