BACKGROUND: Due to the high rate of growth in the incidence and burden of cardiovascular complications, type 2 diabetes mellitus (T2DM) is a significant medical problem in the world. Even in the absence of cardiovascular disease (CVD), patients with T2DM are classified as high and very high risk. In addition to glycemic control, an extremely important aspect of managing this group of patients is prevention of cardiovascular complications. T2DM and hyperlipidemia determines the target group for statins. At the same time, little is known about the frequency of administration of this class of drugs among people with T2DM.AIM: To study prescribing frequency and adherence to statins in outpatients with T2DM and comorbid cardiovascular diseases.METHODS: 156 patients with type 2 diabetes (87.2% — women, average age — 65.2 years) were examined as part of an outpatient appointment with an endocrinologist at the city polyclinic ofTomsk. We used a standard questionnaire compiled on the basis of adapted international methods, including information on cardiac pathology, medications, income level, and Morisky-Green test. Anthropometric parameters, fasting plasma glucose, glycated hemoglobin, lipid spectrum parameters were measured. Methods of parametric and nonparametric statistics were used for comparisons.RESULTS: Statins were prescribed to 45.0% of the surveyed, and 47.0% of them were constantly taking statins. In 41 and 39% of cases, statins were prescribed by an endocrinologist and a cardiologist, respectively. Those taking statins were characterized by a more severe functional class of angina pectoris (p=0.03), a higher prior myocardial infarction rate (p=0.01). For other concomitant diseases, and also indicators of carbohydrate metabolism, differences between the groups were not revealed. One third of patients were adherent (3–4 points), 2/3 were not adherent to treatment (0–2 points), respectively. Patients with incomes between 1 and 2 cost of living took statins more often than the rest (p=0.021).CONCLUSION: An insufficient frequency of prescription and adherence to statin therapy in patients with T2DM was revealed. In most cases, statins were prescribed by an endocrinologist or cardiologist. Functional class of angina pectoris, prior myocardial infarction and moderate income were associated with more frequent use of statins. To increase the coverage of patients with T2DM with statin treatment, more attention needs to be paid to the issues of CVD prevention from both medical professionals and patients.
Disease registries are becoming more and more widely used in various fields of medicine. Especially active implementation of registers is seen in cardiology. In Russia, the records of acute coronary syndrome, arterial hypertension, coronary heart disease, and chronic heart failure were created and are in use nowadays. However, in our country, there are no national registers of cardiac surgery and, in particular, registers of coronary bypass grafting. Besides establishing risk factors and evaluating outcomes, the creation of databases and registers of cardiac surgery helps to solve several problems ranging from analyzing adherence to modern recommendations in daily clinical practice to improving the quality of cardiac surgery. This paper discusses the scientific and organizational approaches to the creation and functioning of a register of patients with cardiovascular disease who underwent coronary artery bypass grafting as well as the promising opportunities of using medical decision support systems based on big data mining.
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