Statin Use and Target Access Rate in Type 2 Diabetes Mellitus Patients: Resistance in Patients or Doctors?

Öz

Aim: Dyslipidemia associated with diabetic subjects is characterized by increased risk of cardiovascular events and is the main cause of morbidity and mortality. Statin therapy is the cornerstone of cardiovascular risk reduction. Current guidelines emphasize that many diabetic patients should be treated with statins. In our study, we aimed to evaluate our practice and the success rates of statin use in  patients with Type 2 Diabetes Mellitus (T2DM) in accordance with current guidelines and to examine the reasons for not using statin in patients and to reveal the factors related to the patient or physician who underwent treatment failure.

Material and Methods: The study included 429 patients with T2DM (223 female, 206 male; mean age: 66.1±8.3 years) who were followed-up by Endocrinology and Metabolism Policlinic between 2016-2018. The records of coronary artery disease (CAD), the use of statin therapy and other related factors, and metabolic parameters were recorded. The need for statin therapy in patients was evaluated according to the recommendations of the 2019 American Diabetes Association (ADA) Guidelines.

Results: The mean LDL-C (Low Density Lipoprotein-Cholesterol) of the patients was 123±43 mg/dL. 48.5% of the patients were receiving statin therapy. The rate of statin use was significantly higher in CAD group (p <0.001). The mean LDL-C of 111 patients with known CAD was 118.3±48.0 mg/dL and 74.8% of them were using statins. 36.1% of patients receiving treatment received highdose statin. LDL-C level was targeted in 13.2% of patients receiving therapy. The mean LDL-C value of 318 patients without CAD was 124.7±41.1 mg/dL. LDL-C level was targeted in 36% of patients receiving therapy. The reason for not using statin therapy in the whole study group; 78.9% physician preference, 19.7% patient preference, 1.4% other reasons; Causes in the group with CAD; 75% physician preference; 21.4% patient preference; 3.6% found as other causes.

Conclusion: Our results show that a significant number of patients with T2DM are not given statin therapy in practice, or that the treatment is not intensified to achieve the goals. In order to evaluate cardiovascular risk factors and patient-physician preferences in more depth, the one-to-one interview phase of the study is ongoing.

Anahtar Kelimeler

• Cardiovascular risk,Coronary artery disease,LDL-C,Statin,Diabetes mellitus

Tip 2 Diabetes Mellitus Hastalarında Statin Kullanımı ve Hedefe Ulaşma Oranları: Direnç Hastada mı Hekimde mi?

Öz

Amaç: Diyabetik bireylerde sıklıkla eşlik eden dislipidemi kardiyovasküler olaylar açısından risk artışı ile karakterizedir ve hastalık sürecinde morbidite ve mortalitenin ana nedenidir. Statin tedavisi kardiyovasküler risk azalmasının temel taşıdır. Güncel kılavuzlar birçok diyabetik hastanın statin ile tedavi edilmesi gerektiğini vurgulamaktadır. Çalışmamızda Tip 2 Diabetes Mellitus (T2DM) tanılı hastalarımızda statin kullanımıyla ilgili günlük pratiğimizi ve tedavi başarı oranlarımızı güncel kılavuzlar doğrultusunda değerlendirmeyi ve hastalarımızda statin kullanmama sebeplerini inceleyerek tedavi başarısızlığının altında yatan hastaya veya hekime yönelik faktörlerin ortaya konulması amaçlanmıştır.

Gereç ve Yöntemler: Çalışmaya 2016-2018 yılları arasında Endokrinoloji ve Metabolizma Polikliniğince takipli 40 yaş ve üzeri 429 T2DM tanılı hasta (223’ü kadın 206’sı erkek, ortalama yaş: 66.1±8.3) katıldı. Veri tabanı kayıtları incelenerek hastalarda Koroner Arter Hastalığı (KAH) varlığı, statin tedavisi kullanımı, bununla ilişkili diğer faktörler ve metabolik parametreler kaydedildi. Hastalarda statin tedavisi gereksinimi 2019 Amerikan Diyabet Cemiyeti (ADA) Kılavuzu önerileri doğrultusunda değerlendirildi.

Bulgular: Çalışmadaki hastaların ortalama LDL-K (Low Density Lipoprotein-Cholesterol-Düşük Dansiteli Lipoprotein-Kolesterol) değeri 123±43 mg/dL bulundu. Hastaların %48.5’i statin tedavisi almaktaydı. Koroner arter hastalığı olan grupta statin kullanım oranı anlamlı olarak yüksek bulundu (p<0.001). Koroner arter hastalığı olan 111 hastanın ortalama LDL-K değeri 118.3±48.0 mg/dL olup bu hastaların %74.8’i statin kullanmaktaydı. Tedavi alan hastaların %36.1’i etkin doz statin (atorvastatin ≥ 40 mg/gün veya rosuvastatin ≥ 20 mg/gün) almaktaydı. Tedavi alan hastaların %13.2’sinde LDL-K düzeyi hedefteydi. Koroner arter hastalığı olmayan 318 hastanın ortalama LDL-K değeri 124.7±41.1 mg/dL olup bu hastaların %39.3’ü statin kullanmaktaydı. Tedavi alan hastaların %36’sında LDL-K düzeyi hedefteydi. Tüm çalışma grubunda statin kullanmayan hastalar değerlendirildiğinde statin tedavisi almama sebebi; %78.9 hekimin tercihi, %19.7 hasta tercihi, %1.4 diğer nedenler iken; KAH olan gruptaki sebepler; %75 hekimin tercihi; %21.4 hasta tercihi; %3.6 diğer nedenler olarak bulundu.

Sonuç: Bulgularımız günlük pratikte T2DM’li önemli sayıda hastada statin tedavisi verilmediği ya da tedavinin hedeflere ulaşacak şekilde intensifiye edilmediğini göstermektedir. Kardiyovasküler risk faktörlerini ve hasta-hekim tercihlerini daha derinlemesine değerlendirmek amacıyla çalışmanın birebir görüşme aşaması sürmektedir.

Anahtar Kelimeler

• Kardiyovaskuler Risk,Koroner Arter Hastalığı,Statin,Diyabetes Mellitus,LDL-K

Kaynakça

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