Utilization of statins and LDL-cholesterol target attainment in Turkish patients with type 2 diabetes - a nationwide cross-sectional study (TEMD dyslipidemia study).
Dyslipidemia
Lipid-lowering treatments
Low-density lipoprotein cholesterol target attainment
Physician inertia
Physicians’ attitudes
Statin cessation
Type 2 diabetes mellitus
Journal
Lipids in health and disease
ISSN: 1476-511X
Titre abrégé: Lipids Health Dis
Pays: England
ID NLM: 101147696
Informations de publication
Date de publication:
11 Nov 2020
11 Nov 2020
Historique:
received:
28
08
2020
accepted:
19
10
2020
entrez:
12
11
2020
pubmed:
13
11
2020
medline:
24
8
2021
Statut:
epublish
Résumé
Attaining acceptable levels of LDL Cholesterol (LDL-C) significantly improves cardiovascular (CV) outcomes in patients with type 2 diabetes mellitus (T2DM). The LDL-C target attainment and the characteristics of patients attaining these targets were investigated in this study. Furthermore, the reasons for not choosing statins and the physicians' attitudes on the treatment of diabetic dyslipidemia were also examined. A nationwide, cross-sectional survey was conducted in tertiary centers for diabetes management. Adult patients with T2DM, who were under follow-up for at least a year in outpatient clinics, were consecutively enrolled for the study. LDL-C goals were defined as below 70 mg/dL for patients with macrovascular complications or diabetic nephropathy, and below 100 mg/dL for other patients. Data about lipid-lowering medications were self-reported. A total of 4504 patients (female: 58.6%) were enrolled for the study. The mean HbA1c and diabetes duration was 7.73 ± 1.74% and 10.9 ± 7.5 years, respectively. The need for statin treatment was 94.9% (n = 4262); however, only 42.4% (n = 1807) of these patients were under treatment, and only 24.8% (n = 448) of these patients achieved LDL-C targets. The main reason for statin discontinuation was negative media coverage (87.5%), while only a minority of patients (12.5%) mentioned side effects. Physicians initiated lipid-lowering therapy in only 20.3% of patients with high LDL-C levels. It was observed that the female gender was a significant independent predictor of not attaining LDL-C goals (OR: 0.70, 95% CI: 0.59-0.83). Less than 50 % of patients with T2DM who need statins were under treatment, and only a quarter of them attained their LDL-C targets. There exists a significant gap between the guideline recommendations and the real-world evidence in the treatment of dyslipidemia in T2DM.
Sections du résumé
BACKGROUND
BACKGROUND
Attaining acceptable levels of LDL Cholesterol (LDL-C) significantly improves cardiovascular (CV) outcomes in patients with type 2 diabetes mellitus (T2DM). The LDL-C target attainment and the characteristics of patients attaining these targets were investigated in this study. Furthermore, the reasons for not choosing statins and the physicians' attitudes on the treatment of diabetic dyslipidemia were also examined.
METHODS
METHODS
A nationwide, cross-sectional survey was conducted in tertiary centers for diabetes management. Adult patients with T2DM, who were under follow-up for at least a year in outpatient clinics, were consecutively enrolled for the study. LDL-C goals were defined as below 70 mg/dL for patients with macrovascular complications or diabetic nephropathy, and below 100 mg/dL for other patients. Data about lipid-lowering medications were self-reported.
RESULTS
RESULTS
A total of 4504 patients (female: 58.6%) were enrolled for the study. The mean HbA1c and diabetes duration was 7.73 ± 1.74% and 10.9 ± 7.5 years, respectively. The need for statin treatment was 94.9% (n = 4262); however, only 42.4% (n = 1807) of these patients were under treatment, and only 24.8% (n = 448) of these patients achieved LDL-C targets. The main reason for statin discontinuation was negative media coverage (87.5%), while only a minority of patients (12.5%) mentioned side effects. Physicians initiated lipid-lowering therapy in only 20.3% of patients with high LDL-C levels. It was observed that the female gender was a significant independent predictor of not attaining LDL-C goals (OR: 0.70, 95% CI: 0.59-0.83).
CONCLUSIONS
CONCLUSIONS
Less than 50 % of patients with T2DM who need statins were under treatment, and only a quarter of them attained their LDL-C targets. There exists a significant gap between the guideline recommendations and the real-world evidence in the treatment of dyslipidemia in T2DM.
Identifiants
pubmed: 33176832
doi: 10.1186/s12944-020-01408-2
pii: 10.1186/s12944-020-01408-2
pmc: PMC7659134
doi:
Substances chimiques
Cholesterol, LDL
0
Glycated Hemoglobin A
0
Hydroxymethylglutaryl-CoA Reductase Inhibitors
0
hemoglobin A1c protein, human
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
237Subventions
Organisme : Society of Endocrinology and Metabolism of Turkey
ID : 04/10/2016-01
Investigateurs
Sibel Guldiken
(S)
Semra Ayturk
(S)
Murat Yilmaz
(M)
Mehmet Asik
(M)
Nevin Dinccag
(N)
Ramazan Cakmak
(R)
Fulya Turker
(F)
Cemile Idiz
(C)
Hulya Hacisahinogullari
(H)
Elif Bagdemir
(E)
Busra Yildiz
(B)
Ozlem Haliloglu
(O)
Seda Sancak
(S)
Levent Ozsari
(L)
Eylem Cagiltay
(E)
Oguzhan Deyneli
(O)
Eren Imre
(E)
Sait Gonen
(S)
S Nur Boysan
(SN)
Yuksel Altuntas
(Y)
Feyza Yener Ozturk
(FY)
Meral Mert
(M)
Hamide Piskinpasa
(H)
Hasan Aydin
(H)
Sazi Imamoglu
(S)
Ozen Oz Gul
(OO)
Sinem Kucuksarac Kiyici
(SK)
Berrin Cetinarslan
(B)
Alev Selek
(A)
Teoman Dogru
(T)
Ali Kirik
(A)
Belgin Efe
(B)
Ahmet Kaya
(A)
Ilker Cordan
(I)
Suleyman Baldane
(S)
Cem Onur Kirac
(CO)
Zehra Capa
(Z)
Mustafa Cesur
(M)
Ilhan Yetkin
(I)
Demet Corapcioglu
(D)
Sule Canlar
(S)
Okan Bulent Yildiz
(OB)
Suleyman Nahit Sendur
(SN)
Bekir Cakir
(B)
Ahmet Corakci
(A)
Mustafa Kutlu
(M)
Neslihan Bascil Tutuncu
(NB)
Yusuf Bozkus
(Y)
Erman Cakal
(E)
Berrin Demirbas
(B)
Sibel Ertek
(S)
Mustafa Altay
(M)
Murat Dagdeviren
(M)
Amir Hossein Abedi
(AH)
Sevki Cetinkalp
(S)
Hatice Ozisik
(H)
Guzide Gonca Oruk
(GG)
Serkan Yener
(S)
Basak Ozgen Saydam
(BO)
Engin Guney
(E)
Mustafa Unubol
(M)
Guzin Fidan Yaylali
(GF)
Senay Topsakal
(S)
Zeliha Hekimsoy
(Z)
Gulhan Akbaba
(G)
Ibrahim Aslan
(I)
Sefika Dalkiran
(S)
Esen Akbay
(E)
Kamile Gul
(K)
Muge Ozsan Yilmaz
(MO)
Emre Bozkirli
(E)
Seher Cetinkaya Altuntas
(SC)
Aysegul Atmaca
(A)
Elif Tutku Durmuş
(ET)
Turkan Mete
(T)
Faruk Kutluturk
(F)
Ferit Kerim Kucukler
(FK)
Oguz Dikbas
(O)
Safak Akin
(S)
Irfan Nuhoglu
(I)
Halil Onder Ersoz Halil Onder Ersoz
(H)
Taner Bayraktaroglu
(T)
Pınar Sisman
(P)
Ibrahim Sahin
(I)
Sedat Cetin
(S)
Ilyas Capoglu
(I)
Emin Murat Akbas
(EM)
Rıfkı Ucler
(R)
Mehmet Ali Eren
(MA)
Alpaslan Kemal Tuzcu
(AK)
Zafer Pekkolay
(Z)
Mesut Ozkaya
(M)
Mustafa Araz
(M)
Références
Circulation. 1999 Sep 7;100(10):1134-46
pubmed: 10477542
N Engl J Med. 2010 Apr 29;362(17):1575-85
pubmed: 20228401
Nutrients. 2013 Apr 12;5(4):1218-40
pubmed: 23584084
Minerva Cardioangiol. 2014 Jun;62(3):287-95
pubmed: 24831765
Eur J Clin Pharmacol. 2016 Mar;72(3):311-9
pubmed: 26581760
Atherosclerosis. 2016 Dec;255:200-209
pubmed: 27667299
Clin Ther. 2008 Nov;30(11):2159-66
pubmed: 19108804
Clin Res Cardiol. 2016 Sep;105(9):783-90
pubmed: 27120330
Atherosclerosis. 2016 Aug;251:248-254
pubmed: 27419905
Endocr Pract. 2017 Apr 2;23(4):479-497
pubmed: 28156151
Curr Med Res Opin. 2017 Jan;33(1):91-100
pubmed: 27646783
Eur Heart J. 2020 Jan 1;41(1):111-188
pubmed: 31504418
Curr Med Res Opin. 2013 Aug;29(8):911-20
pubmed: 23659564
Diabetologia. 2015 May;58(5):886-99
pubmed: 25725623
Am Heart J. 2006 Nov;152(5):976-81
pubmed: 17070174
N Engl J Med. 1993 Sep 30;329(14):977-86
pubmed: 8366922
Diabetes Care. 2017 Jan;40(Suppl 1):S11-S24
pubmed: 27979889
Am Heart J. 2013 May;165(5):665-78, 678.e1
pubmed: 23622903
Ned Tijdschr Geneeskd. 2012;156(36):A5104
pubmed: 22951134
Diabetes Res Clin Pract. 2018 Dec;146:138-147
pubmed: 30244051
Circulation. 1998 Dec 8;98(23):2513-9
pubmed: 9843456
Clin Ther. 2015 Jun 01;37(6):1329-39
pubmed: 25869626
Clin Cardiol. 2017 Mar;40(3):155-162
pubmed: 28026031
BMJ. 1998 Mar 14;316(7134):823-8
pubmed: 9549452
Diabetes Res Clin Pract. 2012 Oct;98(1):75-82
pubmed: 22652276
Clin Ther. 2017 Apr;39(4):819-827.e1
pubmed: 28347514
Lancet. 1998 Sep 12;352(9131):837-53
pubmed: 9742976
Turk Kardiyol Dern Ars. 2017 Dec;45(8):731-738
pubmed: 29226894
BMJ. 2016 Jun 28;353:i3283
pubmed: 27353418
Med J Aust. 2015 Jun 15;202(11):591-5
pubmed: 26068693
J Cardiovasc Pharmacol Ther. 2020 Jul;25(4):307-315
pubmed: 31918567
BMJ Open. 2017 Feb 17;7(2):e013255
pubmed: 28213597
Atherosclerosis. 2018 Jan;268:99-107
pubmed: 29197254
J Clin Lipidol. 2016 Jul-Aug;10(4):833-841
pubmed: 27578114
Lancet. 2003 Jun 14;361(9374):2005-16
pubmed: 12814710
Lancet Diabetes Endocrinol. 2015 Feb;3(2):105-13
pubmed: 25466521
Int J Cardiol. 2016 Apr 15;209:284-90
pubmed: 26913370
Eur J Epidemiol. 2013 Feb;28(2):169-80
pubmed: 23407904
Clin Chem. 1972 Jun;18(6):499-502
pubmed: 4337382
Eur Heart J. 2016 Oct 14;37(39):2999-3058
pubmed: 27567407
Curr Opin Lipidol. 2016 Aug;27(4):313-22
pubmed: 27213628
Eur Heart J. 2016 Mar 14;37(11):908-916
pubmed: 26643266
Sci Rep. 2017 Oct 4;7(1):12648
pubmed: 28978912
N Engl J Med. 2018 Aug 16;379(7):633-644
pubmed: 30110583
Diabetologia. 2016 Nov;59(11):2298-2307
pubmed: 27531506
Eur Heart J. 2018 Feb 1;39(5):337-338
pubmed: 29401252
Lancet. 2004 Aug 21-27;364(9435):685-96
pubmed: 15325833
Diabetes Metab. 2004 Sep;30(4):327-33
pubmed: 15525875
N Engl J Med. 2008 Jun 12;358(24):2560-72
pubmed: 18539916
N Engl J Med. 2002 Nov 7;347(19):1483-92
pubmed: 12421890