Adherence to Clinical Guidelines on STATIN Prescribing Among Diabetic Patients Aged 40–75 Years Old in a Primary Care Setting: A Cross-Sectional Study

Abstract

Background Diabetes mellitus (D.M.) is a chronic metabolic disease caused by decreased insulin secretion, which increases the risk of cardiovascular diseases. Evidence has shown that statins reduce cardiovascular risk in patients with diabetes; moreover, most clinical guidelines recommend statins. Objective This study aimed to assess the level and status of adherence to guidelines on statin prescription in patients with diabetes mellitus in a primary care setting in Palestine. Methods A retrospective cross-sectional descriptive study was conducted at an ambulatory center in Palestine. Data were collected by auditing prescription records and reviewing medical charts of patients with diabetes who visited the clinic from February 15 to March 17, 2021. The collected data included patient characteristics, comorbidities, lipid profiles, and statin prescription. A chi-square test was used to evaluate the appropriateness of the prescribed statins with different demographic and clinical variables. Statistical significance was set at p < 0.05. Statistical Package for Social Sciences (SPSS) version 22 was used to analyze the data. Results Out Of 262 diabetic patients included in the analysis, 74% were prescribed appropriate statin therapy according to the American Diabetes Association (ADA) guidelines, and 24% of patients had inappropriate statin therapy or needed statins. Furthermore, 82.8% were on high-intensity statins, while 11% were not taking any statins. More than 60% of patients had uncontrolled diabetes and hypertension. Conclusion Most guidelines recommend statin therapy in diabetic patients owing to its benefits in preventing cardiovascular complications. In this study, most patients were on appropriate STATIN therapy; however, 50% of diabetic patients had LDL of more than 100 mg/dl, and 25% were not prescribed statins, increasing their risk of ASCVD. Therefore, we recommend strict adherence to the established guidelines on statins prescribed to patients with diabetes to prevent cardiovascular complications, save lives, and reduce healthcare costs.

Provider adherence to American Diabetes Association cardiovascular risk–reduction guidelines: An integrative review

“…The study by Nelson et al (2021) found the proportion of female patients on appropriate statin pharmacotherapy to be 31.4%, whereas the proportion of male patients was 68.6%. Although Abukhalil et al (2022) did not find the same gender skew, they did find that those with known ASCVD were significantly more likely to be prescribed a statin than those who would benefit from preventative use as outlined in the ADA guidelines.…”

“…Significant socioeconomic and geographic variations existed between populations studied, yet the lack of consistent ADA guideline adherence by providers to statin prescription persisted across studies. Abukhalil et al (2022) found that provider adherence to statin prescribing was 74%, whereas Eder et al (2019) found that number closer to 60.5%. Garza et al (2017) was closer to 55.1%.…”

“…Across all studies, there were significant gaps between the ADA guidance and the percentage within each population receiving appropriate statin prescriptions (Abukhalil et al, 2022; Eder et al, 2019; Garza et al, 2017; Nelson et al, 2021). Significant socioeconomic and geographic variations existed between populations studied, yet the lack of consistent ADA guideline adherence by providers to statin prescription persisted across studies.…”

“…The newest revision of the ADA guidelines in 2023 further highlights the importance of high-risk statin pharmacotherapy in higher-risk groups but continues to underscore the use in those adults aged 40–75 years without comorbidity (ElSayed et al, 2023). In addition, 14.9% of those with ASCVD and T2DM were found to be inappropriately on a low- or moderate-intensity statin, when their comorbidities necessitated a high-intensity statin (Abukhalil et al, 2022). Co-occurring management with a cardiologist (Nelson et al, 2021) or with a certified diabetes educator (CDE; Zgibor et al, 2018) may have influenced outcomes as well.…”

“…Atherosclerotic cardiovascular disease (ASCVD) is the primary driver of morbidity and mortality in T2DM (ADA, 2022). Type 2 diabetes mellitus increases stroke and heart attack risk by 2–4 times across the lifetime of those effected (Abukhalil et al, 2022; ADA, 2022). Reduction of ASCVD risk has been clearly linked to blood pressure control (Alborzi et al, 2021) and statin pharmacotherapy initiation (Ahmed et al, 2021).…”