A large remaining potential in lipid‐lowering drug treatment in the type 2 diabetes population: A Danish nationwide cohort study

Abstract

Aim To assess lipid‐lowering drug (LLD) use patterns during 1996‐2017 and examine lipid levels in relation to the use of LLDs and prevalent atherosclerotic cardiovascular disease (ASCVD). Methods Using a nationwide diabetes register, 404 389 individuals with type 2 diabetes living in Denmark during 1996‐2017 were identified. Individuals were followed from 1 January 1996 or date of type 2 diabetes diagnosis until date of emigration, death or 1 January 2017. Redemptions of prescribed LLDs were ascertained from the nationwide Register of Medicinal Products Statistics. Data on lipid levels were sourced from the National Laboratory Database since 2010. LLD coverage was calculated at any given time based on the redeemed amount and dose. Trends in lipid levels were estimated using an additive mixed‐effect model. Low‐density lipoprotein cholesterol (LDL‐C) goal attainment was assessed based on recommended targets by the 2011, 2016 and 2019 guidelines for management of dyslipidaemias. Results LLD use has decreased since 2012 and only 55% of those with type 2 diabetes were LLD users in 2017. A decline in levels of total cholesterol and LDL‐C, and an increase in triglycerides, was observed during 2010‐2017. Annual mean levels of LDL‐C were lower among LLD users compared with non‐users (in 2017: 1.84 vs. 2.57 mmol/L). A greater fraction of LLD users achieved the LDL‐C goal of less than 1.8 mmol/L compared with non‐users (in 2017: 51.7% and 19%, respectively). Among LLD users with prevalent ASCVD, 26.9% and 55% had, as recommended by current 2019 European guidelines, an LDL‐C level of less than 1.4 mmol/L and less than 1.8 mmol/L, respectively, in 2017. Conclusions LLD use and LDL‐C levels are far from optimal in the Danish type 2 diabetes population and improvement in LLD use could reduce ASCVD events.

Guideline-level monitoring, biomarker levels and pharmacological treatment in migrants and native Danes with type 2 diabetes: Population-wide analyses

“…The overall proportion of LLD users in our study (69.4%) was substantially higher than the 55% reported in a recent Danish study of individuals with T2D [ 41 ]. A stricter outcome measure was used in that study, however, as only individuals with continuous LLD coverage throughout the year were defined as users, and the difference may represent lapses in adherence to LLD in our study population.…”

Advances in secondary prevention mechanisms of macrovascular complications in type 2 diabetes mellitus patients: a comprehensive review

“…Annual lipid concentration testing is essential for effective lipid monitoring [ 176 ]. Globally, medications for lowering lipid and LDL-C levels in T2DM patients are far from optimal and present substantial untapped potential [ 181 ]. Moreover, significant global disparities exist in treatment regimens [ 182 ].…”

The effect of virtual specialist conferences between endocrinologists and general practitioners about type 2 diabetes: study protocol for a pragmatic randomized superiority trial

“…Furthermore clinical guidelines are revised regularly as new knowledge and new pharmaceuticals emerge at a rapid pace [9,10]. Unfortunately, these care challenges have led to a wide gap between the recommended pharmacological care and the care that patients receive, both internationally and in Denmark [11][12][13]. Thus, it is urgent to improve the pharmacological management of patients living with T2D.…”