A large remaining potential in lipid‐lowering drug treatment in the type 2 diabetes population – a Danish nationwide cohort study

Abstract Aims/hypothesis We aimed to assess whether general practices (GPs) using an electronic disease management program (DMP) with population overviews, including alerts when patients failed to receive guideline-recommended prescription medications, increased prescriptions of lipid-lowering drugs for patients with type 2 diabetes with no history of lipid-lowering treatment. Methods This observational study included 165 GPs that reached a high level of use of the DMP in 2012 and a control group of 135 GPs who reached a high level of use in 2013 and, hence, who were less exposed to the DMP throughout 2012. A binary measure for having been prescribed and filled lipid-lowering drugs at any time within a 12-month exposure period was derived for all patients with type 2 diabetes who did not receive a prescription for lipid-lowering drugs in the baseline year prior to the study period (i.e. 2011). Results were derived using ORs from multivariate logistic regression analyses. Subgroup stratification based on age, sex, diabetes duration, deprivation status and Charlson Comorbidity Index (CCI) score was conducted and assessed. Placebo tests were carried out to assess bias from selection to treatment. Results Patients who did not receive a prescription of lipid-lowering drugs in the year prior to being listed with GPs that used the DMP had statistically significant greater odds of receiving a prescription of lipid-lowering medications when compared with individuals who attended control GPs (OR 1.23 [95% CI 1.09, 1.38]). When the analysis period was shifted back by 2 years, no significant differences in lipid-lowering drug prescription between the two groups were found to occur, which indicates that these results were not driven by selection bias. Subgroup analyses showed that the increase in lipid-lowering drug prescriptions was primarily driven by changes among male participants (OR 1.32 [95% CI 1.12, 1.54]), patients aged 60–70 years (OR 1.40 [95% CI 1.13, 1.74]), patients with a diabetes duration of ≤5 years (OR 1.33 [95% CI 1.13, 1.56]), non-deprived patients (OR 1.25 [95% CI 1.08, 1.45]) and patients without comorbidities (CCI score = 0; OR 1.27 [95% CI 1.11, 1.45]). Conclusions/interpretation Access to population overviews using a DMP with alerts of clinical performance measures with regard to adhering to guideline-recommended prescription of medications can increase GP prescriptions of lipid-lowering drugs. Graphical abstract

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Short- and long-term association of lipid-lowering drug treatment and cardiovascular disease by estimated absolute risk in the Second Australian National Blood Pressure study

Journal of Clinical Lipidology ◽

10.1016/j.jacl.2018.08.014 ◽

2019 ◽

Vol 13 (1) ◽

pp. 148-155

Author(s):

Chau L.B. Ho ◽

Enayet K. Chowdhury ◽

Monique Breslin ◽

Jenny Doust ◽

Christopher M. Reid ◽

...

Keyword(s):

Blood Pressure ◽

Cardiovascular Disease ◽

Drug Treatment ◽

Absolute Risk ◽

Lipid Lowering ◽

Lipid Lowering Drug ◽

Blood Pressure Study ◽

Short And Long Term ◽

Lowering Drug

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Social Deprivation and Incident Diabetes-Related Foot Disease in Patients With Type 2 Diabetes: A Population-Based Cohort Study

10.2337/figshare.13476807.v1 ◽

2021 ◽

Author(s):

Jenny Riley ◽

Christina Antza ◽

Punith Kempegowda ◽

Anuradhaa Subramanian ◽

Joht Singh Chandan ◽

...

Keyword(s):

Type 2 Diabetes ◽

Cohort Study ◽

Social Deprivation ◽

Population Based ◽

Incident Diabetes ◽

Lipid Lowering ◽

Diabetes Diagnosis ◽

Newly Diagnosed ◽

Foot Disease

Objective: To investigate the relationship between social deprivation and incident diabetes-related foot disease (DFD), in newly-diagnosed patients with type 2 diabetes. Research design and methods: A population-based, open retrospective cohort study, using The Health Improvement Network (01/01/2005-31/12/2019). Patients with type 2 diabetes, free of DFD at baseline, were stratified by Townsend deprivation index and the risk of developing DFD was calculated. DFD was defined as a composite of foot ulcer (FU), Charcot arthropathy, lower limb amputation (LLA), peripheral neuropathy (PN), peripheral vascular disease (PVD) and gangrene. Results: 176,359 patients were eligible (56% men; aged 62.9±13.1years). After excluding 26,094 patients with DFD before/within 15 months of type 2 diabetes diagnosis, DFD was incidentally developed in 12.1% of study population during 3.27years (IQR:1.41-5.96). Patients in the most deprived Townsend quintile had increased risk of DFD compared to those in the least deprived (aHR:1.22, 95%CI:1.16-1.29) after adjusting for sex, age at type 2 diabetes diagnosis, ethnicity, smoking, BMI, HbA1c, cardiovascular disease, hypertension, retinopathy, eGFR, insulin, glucose/lipid-lowering medications and baseline foot risk. Patients in the most deprived Townsend quintile had higher risk of PN (aHR:1.18, 95%CI:1.11-1.25), FU (aHR:1.44, 95%CI:1.17-1.77), PVD (aHR:1.40, 95%CI:1.28-1.53) LLA (aHR:1.75, 95%CI:1.08-2.83) and gangrene (aHR:8.49, 95% CI:1.01-71.58) compared to those in the least. Conclusion: Social deprivation is an independent risk factor for the development of DFD, PN, FU, PVD, LLA and gangrene in newly-diagnosed patients with type 2 diabetes. Considering the high individual and economic burden of DFD, strategies targeting patients in socially deprived areas are needed to reduce health inequalities.

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Healthcare Cost Development in a Type 2 Diabetes Patient Population on Glucose-Lowering Drug Treatment: A Nationwide Observational Study 2006–2014

PharmacoEconomics - Open ◽

10.1007/s41669-017-0063-y ◽

2017 ◽

Vol 2 (4) ◽

pp. 393-402 ◽

Cited By ~ 6

Author(s):

David Nathanson ◽

Ugne Sabale ◽

Jan W. Eriksson ◽

Thomas Nyström ◽

Anna Norhammar ◽

...

Keyword(s):

Type 2 Diabetes ◽

Observational Study ◽

Drug Treatment ◽

Patient Population ◽

Diabetes Patient ◽

Glucose Lowering ◽

Cost Development ◽

Lowering Drug ◽

Nationwide Observational Study

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Lack of adherence to lipid-lowering drug treatment. A comparison of utilization patterns in defined populations in Funen, Denmark and Bologna, Italy

British Journal of Clinical Pharmacology ◽

10.1046/j.1365-2125.2000.00192.x ◽

2000 ◽

Vol 49 (5) ◽

pp. 463-471 ◽

Cited By ~ 38

Author(s):

John Larsen ◽

Alberto Vaccheri ◽

Morten Andersen ◽

Nicola Montanaro ◽

Ulf Bergman

Keyword(s):

Drug Treatment ◽

Lipid Lowering ◽

Lipid Lowering Drug ◽

Utilization Patterns ◽

Lowering Drug

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Abstract P047: Improved Clinical Outcomes Associated with Dual-Goal (HbA1c and LDL-C) Achievement in Newly Diagnosed Type 2 Diabetes Mellitus

Circulation ◽

10.1161/circ.127.suppl_12.ap047 ◽

2013 ◽

Vol 127 (suppl_12) ◽

Author(s):

Lizheng Shi ◽

Xin Ye ◽

Mei Lu ◽

Eric Q Wu ◽

Hari Sharma ◽

...

Keyword(s):

Index Date ◽

Microvascular Complications ◽

Goal Achievement ◽

Lipid Lowering ◽

Newly Diagnosed ◽

Factors Associated ◽

Lipid Lowering Drug ◽

Clinical Benefits ◽

Lowering Drug

Background: Compared with studies on achieving a single goal of either glycated hemoglobin (HbA1c) or low-density lipoprotein cholesterol (LDL-C) in type 2 diabetes mellitus (T2DM), the clinical benefits of dual-goal achievement (LDL-C<100 mg/dl and HbA1c<7%) are not well documented. This study investigated factors and clinical benefits associated with dual-goal achievement in newly diagnosed T2DM patients. Methods: Newly diagnosed adult T2DM patients with ≥2 measures of LDL-C and HbA1c were identified in the Veterans Integrated Services Network 16 data warehouse (01/2004-06/2010). A logistic regression model was used to identify factors associated with dual-goal achievement during 7-12 months following the index date (first HbA1c recorded within three months of the first T2DM diagnosis). Factors included demographics and 0-6 month dual-goal achievement, as well as diabetes-related comorbidities, medications, surgeries, and healthcare utilization, all measured during the 1-year period surrounding the index date. Multivariate Cox proportional hazards models were used to assess the association between time-varying goal achievement status and post-index date clinical outcomes, including microvascular complications (retinopathy, nephropathy, and neuropathy), cardiovascular-related complications (cardiovascular death, stroke, or myocardial infarction) and acute coronary syndromes (ACS). Results: A total of 16,829 T2DM patients were included in the study. Factors associated with an increased likelihood of dual-goal achievement include older age, higher Charlson Comorbidity Index (CCI), prior dual-goal achievement, diagnosis of ketoacidosis or hypersmolarity, and lipid-lowering drug use. Conversely, patients with prior diagnoses of retinopathy, neuropathy, and congestive heart failure, as well as prior insulin use were less likely to achieve both goals. Compared with failure to achieve either goal, achieving only LDL-C goal was associated with a lower risk of cardiovascular-related complications (HR:0.76; 95% CI:0.71-0.81) and ACS (HR:0.76; 95% CI:0.67-0.86), while achieving only HbA1C goal was associated with a lower risk of microvascular complications (HR:0.73; 95% CI:0.71-0.74), cardiovascular-related complications (HR:0.80; 95% CI:0.74-0.87) and ACS (HR:0.66; 95% CI:0.60-0.72). Dual-goal achievement was associated with additional reduction in risk of microvascular complications (HR: 0.69; 95% CI: 0.63-0.76) vs. only LDL-C goal achievement, but had similar risk to achieving HbA1c goal alone. Conclusions: Older age, higher CCI, prior dual-goal achievement, and lipid-lowering drug use were associated with a greater likelihood of dual-goal achievement. Dual-goal achievement in newly diagnosed T2DM patients is associated with decreased risks of microvascular complications than those with only LDL-C goal achievement.

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