Utilization of statins and LDL-cholesterol target attainment in Turkish patients with type 2 diabetes - a nationwide cross-sectional study (TEMD dyslipidemia study)

Abstract

Background Attaining acceptable levels of LDL Cholesterol (LDL-C) significantly improves cardiovascular (CV) outcomes in patients with type 2 diabetes mellitus (T2DM). The LDL-C target attainment and the characteristics of patients attaining these targets were investigated in this study. Furthermore, the reasons for not choosing statins and the physicians’ attitudes on the treatment of diabetic dyslipidemia were also examined. Methods A nationwide, cross-sectional survey was conducted in tertiary centers for diabetes management. Adult patients with T2DM, who were under follow-up for at least a year in outpatient clinics, were consecutively enrolled for the study. LDL-C goals were defined as below 70 mg/dL for patients with macrovascular complications or diabetic nephropathy, and below 100 mg/dL for other patients. Data about lipid-lowering medications were self-reported. Results A total of 4504 patients (female: 58.6%) were enrolled for the study. The mean HbA1c and diabetes duration was 7.73 ± 1.74% and 10.9 ± 7.5 years, respectively. The need for statin treatment was 94.9% (n = 4262); however, only 42.4% (n = 1807) of these patients were under treatment, and only 24.8% (n = 448) of these patients achieved LDL-C targets. The main reason for statin discontinuation was negative media coverage (87.5%), while only a minority of patients (12.5%) mentioned side effects. Physicians initiated lipid-lowering therapy in only 20.3% of patients with high LDL-C levels. It was observed that the female gender was a significant independent predictor of not attaining LDL-C goals (OR: 0.70, 95% CI: 0.59–0.83). Conclusions Less than 50 % of patients with T2DM who need statins were under treatment, and only a quarter of them attained their LDL-C targets. There exists a significant gap between the guideline recommendations and the real-world evidence in the treatment of dyslipidemia in T2DM.

Management of LDL‐cholesterol levels in patients with Diabetes Mellitus in Cardiology Practice: Real‐life evidence of Under‐treatment from the EPHESUS registry

“…In recently published TEMD dyslipidaemia study, which was conducted in nationwide tertiary endocrine units in Turkey between 01 April and 30 June 2017 also demonstrated a 20.5% LDL‐C target attainment (32.7% in high‐risk and 10.8% in very high‐risk groups) in patients with DM 24 . In TEMD study, of the type II diabetics only 24.5% had had cardiovascular disease.…”

Treatment Patterns and Associated Clinical Outcomes in Type 2 Diabetes Patients Initiating Second-Line Glucose-Lowering Therapy: Interim Analysis of Baseline Data from Turkey Arm of the Global DISCOVER Study

“…The LDL-C (<100 mg/dL) and BP (<130/80 mmHg) goal achievement rates were 25% and 23% in the ADMIRE study (27), while 35% and 20% in the IDMPS study, respectively (28). In the TEMD Dyslipidemia Study among 4,504 T2D patients, only 8.4% of patients attained target LDL-C levels, and 44.8% of patients were on statin treatment despite the need for statin therapy in 89.5% along with achieving target LDL-C levels by only a quarter of patients on statin therapy (30). Data from TEMD Hypertension Study in 4,756 T2D patients revealed hypertension in 67.5% of patients and 87.4% of hypertensive patients received treatment; BP was on target only in 52.7% of patients (31).…”

Kidney Disease in Diabetic Patients: From Pathophysiology to Pharmacological Aspects with a Focus on Therapeutic Inertia

“…It has been demonstrated that maintaining blood pressure values below 140/85 mmHg is associated with a statistically significant reduction in the incidence of DKD in patients with hypertension and T2DM over a 4-year follow-up [ 103 ]. However, real-world evidence suggests that, despite the improvements in risk-factor control and diabetes management, glycemic, blood pressure, and LDL-cholesterol target levels are achieved only in a small proportion of T2DM patients, especially if concomitantly affected by CKD [ 101 , 104 , 105 , 106 ]. These gaps in diabetes care might be generally explained by several factors, such as the patients’ lack of motivation, the therapeutic inertia by the care providers, and, more generally, the logistical or financial barriers in the patients’ access to care [ 101 ].…”