Statins are under-prescribed in patients with type 2 diabetes who are receiving anti-hyperglycemic agents, according to an analysis of medical records from a large database.
The results show that slightly over one third of the patients with type 2 diabetes who are considered to be eligible for statin therapy in accordance with ADA guidelines do not receive a statin prescription.
The findings underscore the need for a more integrated therapeutic approach in type 2 patients, said Alex Z. Fu, PhD, an assistant professor in the department of quantitative health sciences at Cleveland Clinic in Ohio. “Physicians should treat both diabetes and lipids simultaneously by prescribing diabetes medications and statins concomitantly in appropriate patients,” he said.
Dr. Fu and his group estimated the percentage of patients with type 2 diabetes treated with anti-hyperglycemic agents who needed a statin based on ADA recommendations and the percentage of patients who received a statin in clinical practice. “Because type 2 diabetes is considered a coronary heart disease risk ‘equivalent’, the use of statins is widely recommended in current treatment guidelines for patients with type 2 diabetes.”
According to recommendations included in the ADA Standards of Medical Care in Diabetes published in 2008, statin therapy should be prescribed to the following groups of patients with type 2 diabetes:
- patients with overt cardiovascular disease (CVD), regardless of their low-density lipoprotein cholesterol (LDL-C) level;
- patients without overt CVD, who are 40 years of age or older and have one or more of several CVD risk factors regardless of their LDL-C level;
- patients without overt CVD who are less than 40 years of age and have multiple CVD risk factors; and
- patients with an LDL-C greater than 100 mg/dL.
The 113,906 patients with type 2 diabetes included in the analysis were drawn from the General Electric Healthcare’s electronic medical record database and were at least 25 years old and had received a prescription for an oral or injectable anti-hyperglycemic prescription between July 2006 and June 2008. Patient eligibility for statin therapy according to the ADA recommendations was assessed using patient medical records one year prior to and one year after the date of their first anti-hypoglycemic prescription. Concomitant statin use with anti-hyperglycemic therapy was based on prescription records during the follow-up.
While 98% of patients satisfied ADA eligibility standards for statin therapy, only 64% of eligible patients actually received a statin prescription, Dr. Fu said. Overall, 34% of eligible patients were not prescribed a statin. Statins were more likely to be underused in patients under age 50.
Dr. Fu cautioned that the analysis did not exclude patients who may be intolerant of statins or have contraindications to statin use. “This may be a potential study limitation,” he said.
In addition, data on a family history of premature coronary heart disease were not available, which might result in an underestimation of patients’ cardiovascular risk along with their eligibility for statin therapy.
Finally, Dr. Fu said he hopes that fixed-dose combinations of statins and diabetes medications will become available to patients that will be an easier and more convenient way of treating co-existing diabetes and dyslipidemia.