Statin prescription among patients with type 2 diabetes in Botswana: findings and implications

Abstract

Background: There is evidence of statin benefit among patients with diabetes regardless of cholesterol levels or prior cardiovascular disease history. Despite the evidence, there is under-prescription of statins in clinical practice. This study aimed to assess statin prescriptions and associated factors among patients with type 2 diabetes in Botswana. Methods: The study was a secondary data analysis of 500 randomly selected type 2 diabetes patients at a specialised diabetes clinic at Gaborone, Botswana. We assessed the proportion of statin-eligible patients who are prescribed statins and evaluated the adjusted associations between various factors and statin prescriptions. Results: Overall, 477 (95.4%) participants were eligible for a statin prescription. Clinicians prescribed statins in 217 (45.5%) of eligible participants, and only one (4.4%) ineligible participant. The probability of a statin prescription was higher in participants with high baseline low-density lipoprotein cholesterol (risk ratio [RR]: 1.49; 95%CI: 1.17-1.89), increasing duration of diabetes (RR: 1.01; 95%CI 1.00-1.03) and the presence of chronic kidney disease (RR: 1.35; 95%CI: 1.06-1.74). Conclusion: A large proportion with type 2 diabetes in Gaborone is not receiving statins. Clinicians did not consider most guideline-recommended indications for statin prescriptions. The findings call for improvement in diabetes quality of care by implementing evidence-based guideline recommendations.

Statin Prescription Patterns and Associated Factors Among Patients with Type 2 Diabetes Mellitus Attending Diabetic Clinic at Muhimbili National Hospital, Dar es Salaam, Tanzania

“…It was found that statins were prescribed in about half of the participants with T2DM who were eligible for prescription. Findings of this study were similar to those found by Mwita et al, 32 Demoz et al 33 and Gupta et al 23 and in which statin prescriptions were 45.5% and 55.7%, respectively. The explanation for such a low prescription rate could be due to the following reasons: firstly, lack of local guidelines, secondly, inadequate adherence to already recommended international guidelines, 33 , 34 and thirdly, limited access to medications and lipid tests due to poor socioeconomic status.…”

“…Of those patients who received statins (n = 187), moderate intensity statins prescription was the only pattern found in 47.3%, similarly to 46.1% in the study done by Dermoz et al 32 Likewise, almost half of patients (166; 47.7%) in a high risk group (n = 348) were prescribed with moderate-dose statins, contrary to the recommendations 12 , 35 while more than half in this group did not receive statins despite being at high risk.…”

Metabolic Control and Determinants Among HIV-Infected Type 2 Diabetes Mellitus Patients Attending a Tertiary Clinic in Botswana

“…This compares to findings of Mwita et al in the same clinic in Botswana who found 45.5% of eligible diabetes patients were on statins. 73 Our findings are also worse than those of diabetic HIV-infected patients in Tanzania where approximately one-third of patients were on statins. Our results emphasize the need to remind physicians even in a tertiary care setting on the importance of prescribing statins to reduce LDL-C levels and subsequent cardiovascular events in eligible patients, and we will be following this up.…”

Potentially inappropriate prescribing for adults living with diabetes mellitus: a scoping review

“…Statins have been demonstrated to reduce the risk of CV events and death in people with DM when given as primary or secondary prevention [ 61 , 62 ]. Consequently, not prescribing a statin therapy to an eligible adult with DM was considered as inappropriate in 28 included studies [ 2 , 24 – 34 , 58 , 63 – 74 ], (Diab MI, unpublished; Aketchi IE, unpublished; Langenhoven W, unpublished).…”