Mode of treatments and achievement of treatment targets among type 2 diabetes patients with different comorbidities – a register-based retrospective cohort study in Finland

Abstract

Aims Type 2 diabetes (T2D) is a progressive disease often associated with comorbidities that complicate the management of T2D and affect the achievement of treatment targets. However, adherence to guidelines and individualized treatments can potentially improve treatment outcomes. This study assessed the association between different glucose lowering and lipid lowering medication lines and the achievement of treatment targets with different comorbidities among a T2D cohort in North Karelia, Finland (2011-12 to 2015-16). Methods The data on all diagnosed T2D patients (n = 10,190) in North Karelia were collated retrospectively from regional electronic health records (EHRs). Analyses were performed considering the age, sex, and comorbidities such as cardiovascular diseases (CVD) and any mental disorders (AMD). We analyzed the trends in using glucose lowering and lipid lowering medications and the effect of changes in medication on the achievement of treatment targets among different patient groups. Results Metformin was the most common treatment in all patient groups. The use of only metformin declined and the use of metformin and/or other non-insulin medications increased during the follow-up. A Combination of insulin and non-insulin medication was mostly used by T2D patients with both cardiovascular diseases and mental disorders (T2D + CVD + AMD), and the use of insulin increased among this group in follow-up. Achievement of the glucose treatment target deteriorated even after the intensification of medication among all patient groups during the follow-up. A considerably higher number of patients with T2D + AMD and T2D + CVD + AMD did not use lipid lowering medication when compared to the T2D + CVD patients both at baseline and follow-up. However, the achievement of the LDL treatment target improved during the follow-up. Conclusion Achievement of the glucose target deteriorated even after the intensification of treatment, and especially among patients with multiple diseases. Many T2D patients with AMD and CVD remained without lipid lowering medication, which needs further attention.

Cardiovascular risk management among individuals with type 2 diabetes and severe mental illness: a cohort study

“…Our findings on prescription of lipid-modifying drugs (statins) by SMI status align with the few previous studies that have investigated this [ 16 , 17 ]. A Danish study reported that having a hospital diagnosis of depression was associated with a greater likelihood of initiation of treatment with lipid-modifying drugs, but they did not stratify by history of CVD [ 17 ].…”

“…Previous studies on SMI and cardiovascular risk management in people with diabetes have focused on investigating lipid levels [ 12 – 18 ], BP [ 13 – 15 ] and/or glycaemic levels [ 12 , 14 – 18 ], as these key cardiovascular risk factors can be managed pharmacologically if lifestyle modification is ineffective [ 13 – 19 ]. The findings are contradictory, with some studies reporting no difference in risk factor levels [ 13 , 14 , 16 ] and others finding either better [ 17 ] or worse [ 12 ] lipid levels, better BP [ 15 ], and better [ 12 ] or worse [ 15 , 18 ] glycaemic management among those with SMI. In the UK, clinical guidelines indicate that lipid-modifying medication (statins) should be offered to all those with diabetes over 40 years of age, irrespective of cholesterol levels [ 20 ].…”

“…In the UK, clinical guidelines indicate that lipid-modifying medication (statins) should be offered to all those with diabetes over 40 years of age, irrespective of cholesterol levels [ 20 ]. Only two studies have compared prescribing of lipid-modifying medication by SMI status, reporting that compared to patients without mental illness, patients with SMI were less likely to receive a lipid-modifying medication prescription [ 13 , 16 ]. However, the findings from existing studies are limited by either a small sample size [ 13 ], possible selection bias [ 14 , 16 – 18 ] and conflicting findings [ 12 – 18 ].…”

“…Only two studies have compared prescribing of lipid-modifying medication by SMI status, reporting that compared to patients without mental illness, patients with SMI were less likely to receive a lipid-modifying medication prescription [ 13 , 16 ]. However, the findings from existing studies are limited by either a small sample size [ 13 ], possible selection bias [ 14 , 16 – 18 ] and conflicting findings [ 12 – 18 ]. Moreover, most studies did not differentiate between types of SMI [ 13 – 16 , 18 ].…”

“…However, the findings from existing studies are limited by either a small sample size [ 13 ], possible selection bias [ 14 , 16 – 18 ] and conflicting findings [ 12 – 18 ]. Moreover, most studies did not differentiate between types of SMI [ 13 – 16 , 18 ]. We sought to address these limitations by comparing achievement of lipid, BP and glycaemic targets 1 year after type 2 diabetes diagnosis by SMI status in Scotland, using a national cohort study.…”