Therapeutic inertia in the management of dyslipidaemia and hypertension in incident type 2 diabetes and the resulting risk factor burden: Real‐world evidence from primary care

Abstract

Objective: To investigate trends in the prevalence of hypertension and dyslipidaemia in incident type 2 diabetes (T2DM), time to antihypertensive (AHT) and lipid-lowering therapy (LLT), and the association with systolic blood pressure (SBP) and lipid control.Research Design and Methods: Using The Health Improvement Network UK primary care database, 254 925 people with incident T2DM and existing dyslipidaemia or hypertension were identified. Among those without atherosclerotic cardiovascular disease (ASCVD) history and not on AHT or LLT at diagnosis, the adjusted median months to initiating an AHT or an LLT, and the probabilities of high SBP or lipid levels over 2 years in people initiating therapy within or after 1 year were evaluated according to high and low ASCVD risk status.Results: At diabetes diagnosis, 66% and 66% had dyslipidaemia and hypertension, respectively. During 2005 to 2016, dyslipidaemia prevalence increased by 10% in people aged <60 years, while hypertension prevalence remained stable in all age groups. Among those with high ASCVD risk status in the age groups 18 to 39, 40 to 49, and 50 to 59 years, the median number of months to initiation of therapy were 20.4

Gender Differences in the Diagnosis of Dyslipidemia: ESCARVAL-GENERO

“…In 2021, a study was conducted on therapeutic inertia in dyslipidemia and hypertension in patients with type 2 diabetes mellitus [ 42 ]. The authors observed a significant delay in initiating treatment for primary prevention in both cases, regardless of cardiovascular risk, and in all age groups.…”

PoLA/CFPiP/PCS/PSLD/PSD/PSH guidelines on diagnosis and therapy of lipid disorders in Poland 2021

“…In the IMPROVE-IT study, in the subgroup of patients with diabetes, ezetimibe in addition to simvastatin was particularly effective, reducing the relative risk by 15% (95% CI: 6-22%), and the absolute risk by 5.5% [297]. The FOURIER study demonstrated that therapy with a PCSK9 inhibitor provides similar benefits in pa- Very high Type 2 diabetes with organ damage 1 or other major risk factors 2,3 , type 1 diabetes with early onset and duration > 20 years…”

“…The significance of therapeutic inertia, either in the form of inadequate therapy (usually the lack of intensive statin treatment or, even less likely, combination therapy) or evident errors such as dose reduction or cessation of treatment following achievement of the therapeutic target, also cannot be diminished. That is why in Poland there are still nearly 20 million individuals with hypercholesterolaemia, most of them unaware of their condition [ 3 ]; that is why only ca. 5% of patients with familial hypercholesterolaemia out of predicted as much as 140,000 have been diagnosed; that is why other rare cholesterol metabolism disorders are so rarely diagnosed in Poland [ 4 , 5 ].…”

2021 PoLA/CFPiP/PCS/PSLD/PSD/PSH guidelines on the diagnosis and therapy of lipid disorders in Poland

“…Organ damage is defined as the presence of microalbuminuria, retinopathy, neuropathy, and/or left ventricular muscle damage; 2 other means at least 2 or more;3 major risk factors include: age ≥ 65 years, hypertension, dyslipidaemia, tobacco smoking, obesity; 4 not applicable to type 1 diabetes in young adults (< 35 years of age) with duration of diabetes < 10 years.…”