Underutilization of statins in patients with type 2 diabetes in US clinical practice: a retrospective cohort study

Abstract

Objectives:

To estimate the proportion of patients with type 2 diabetes who were eligible for statin treatment per American Diabetes Association (ADA) recommendations and the proportion who were actually prescribed a statin in US clinical practice. Factors associated with receiving a statin prescription were also determined.

Methods:

Patients ≥25 years diagnosed with type 2 diabetes or had received prescriptions for antihyperglycemic agents between 7/2006 and 6/2008 were identified within a large electronic medical record database. Eligibility for statin therapy was determined according to 2008 ADA recommendations. Statin use was assessed based on prescription records during a 12-month follow-up period. An adjusted logistic regression analysis was performed to estimate the likelihood of statin use in relation to selected baseline characteristics.

Results:

Of the 125,464 patients identified, 98.5% were eligible for statin therapy. Only 62.9% received a statin prescription during follow-up period. In an adjusted logistic regression, factors associated with increased likelihood of statin use were older age, male gender, smoking, history of cardiovascular conditions, and receiving an antihyperglycemic, antihypertensive, or anticoagulant prescription at baseline (all p < 0.05).

Limitations:

Of the patients who did not receive statin during follow-up, 13% of them were previously on a statin during the baseline period. The reasons for discontinuing therapy are not known. It cannot be excluded that some of these patients were intolerant or had contraindications to statin. The data on prescription dispensing and compliance were not recorded.

Conclusions:

Nearly all patients with type 2 diabetes were eligible for statin therapy, but less than two-thirds received statin therapy in US clinical practice. Efforts to minimize this gap are warranted.

Key words::

• Cardiovascular risk
• Clinical inertia
• Statins
• type 2 diabetes

Transparency

Declaration of funding

This analysis was supported by funding provided by Merck Sharp & Dohme, Corp., Whitehouse Station, NJ, USA.

Declaration of financial/other relationships

Q.Z., M.J.D., L.R., and T.S. have disclosed that they are employees of Merck Sharp & Dohme, Corp.

A.Z.F. received research grant support from Merck Sharp & Dohme, Corp. for this study. S.R.P. has disclosed that he was a research fellow at Merck Sharp & Dohme, Corp. at the time of this study. CMRO peer reviewers may have received honoraria for their review work. The peer reviewers on this manuscript have disclosed that they have no relevant financial relationships.

Acknowledgments

This study was presented at the American Heart Association Scientific Sessions in Chicago, IL (November 13–17, 2010).