Abstract 18546: Patients with Type 2 Diabetes are Undertreated with Statins in the United States
Introduction: Type 2 diabetes (T2DM) is considered a coronary heart disease risk equivalent. Statins have been shown to reduce the risk of cardiovascular disease (CVD) in patients (pts) with T2DM and is widely recommended in treatment guidelines for pts with T2DM. The purpose of this study was to estimate, in US clinical practice, the proportion of pts with T2DM who required statin treatment per American Diabetes Association (ADA) recommendations and the proportion of pts who were actually prescribed a statin, and to evaluate factors associated with receiving a statin prescription (Rx).
Methods: The study used GE Healthcare's electronic medical records database, and included pts who were ≥25 yrs with a T2DM diagnosis or receiving a Rx for antihyperglycemic agents (oral or insulin) between 7/2006 and 6/2008 (index period). The index date was the date of the first recorded T2DM diagnosis or first antihyperglycemic agents Rx within the index period. Pt eligibility for statins according to ADA 2008 recommendations was assessed using medical records 1 yr prior to (baseline) and 1 yr after (follow-up) the index date. Statin use was evaluated based on Rx records during the follow-up. Logistic regression was performed to estimate the likelihood of statin use in relation to baseline characteristics, comorbidities, clinical and lab measures, and concomitant medication use.
Results: Of the 125,464 pts with T2DM, mean (SD) age was 64 (13) yrs, 48% were male, and 6.3% had cardiovascular conditions at baseline. While 98.5% of the pts were eligible for statin therapy based on ADA criteria, only 63% actually received a statin Rx. The proportion of pts who had an LDL-C ≥100 mg/dL at baseline was 35% and 50%, respectively, for pts with or without statin Rx at baseline. The adjusted logistic regression showed that increasing age, male gender, smoking, baseline antihypertensive Rx, and baseline blood thinner Rx were associated with increased likelihood of statin use (all p<0.001).
Conclusion: Almost all pts with T2DM were eligible for statin therapy per ADA criteria, however only 63% received a statin Rx in our study. Thus statins are underused in current clinical practice and a more integrated disease management approach is needed to improve statin use in this high CVD risk population.
- © 2010 by American Heart Association, Inc.