SummaryAimsTo estimate the prevalence of dyslipidaemias in high-risk patients new to lipid-modifying therapy (LMT), and establish the extent to which these lipid abnormalities are addressed by treatment in UK clinical practice.MethodsThe PRIMULA study was a retrospective analysis, conducted using the UK General Practice Research Database. Two periods were studied as follows: a pretreatment period, defined as the 12 months before initiation of LMT (the index date), and a follow-up period of at least 12 months. Patients included in the study (n = 25,011) had dyslipidaemia with at least one abnormal lipid measurement [total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) or triglycerides (TG)] in the pretreatment period. All patients were at high risk of cardiovascular events, which was defined as having a history of cardiovascular disease, a 10-year Framingham risk score higher than 20%, diabetes or hypertension, as defined by the Joint British Societies 2 guidelines.ResultsAt the index date, 98% of patients were initiated on statin monotherapy. After 12 months of treatment, 15.2% (sub-group range: 11.0–22.9%) of all high-risk patients had no lipid abnormalities. The proportions of patients with high TC or LDL-C levels decreased from 98.8% to 68.9%, and from 99.2% to 68.7%, respectively, over 12 months. The prevalence of high TG levels decreased from 45.0% to 26.9%, whereas that of low HDL-C levels increased, from 16.6% to 18.0%. Risk factors for cardiovascular events were not consistently associated with the likelihood of attaining optimal lipid levels.ConclusionsDespite widespread use of statins, many individuals at high risk of cardiovascular events have persistently abnormal lipid levels, with over two-thirds of patients not achieving target levels of LDL-C or TC. Management of dyslipidaemia is therefore suboptimal in this important high-risk group in UK standard practice.

Adherence to NICE guidance for initiating and continuing GLP-1 receptor agonists is low. However, lack of data on ethnicity (for assessing NICE's BMI criteria) and on contraindications and/or hypersensitivity to other diabetes medication in the treatment pathway have limited our ability to fully assess adherence to GLP-1 prescribing. Further research is warranted to better understand general practitioners' prescribing decisions given the cost of prescribing GLP-1 receptor agonists.

This study found a statistically significant higher rate of inpatient admissions for macrovascular complications and cardiology outpatient visits and, overall, a directionally higher rate of secondary healthcare utilization for patients prescribed metformin + SU than for those prescribed metformin + OHA. This adds to the evidence that long-term and health economic outcomes should be considered in treatment decisions for patients with type 2 diabetes.

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Objectives: Due to its dramatically increasing prevalence, type 2 diabetes mellitus (T2DM) is a serious public health concern in Saudi Arabia. Few data have been published that describe how persons with T2DM are managed in clinical practice; we aimed to characterize recent treatment patterns among individuals treated for T2DM in Riyadh, Saudi Arabia. MethOds: Charts from 455 adults with T2DM who visited the King Fahad National Guard Hospital from October 2009 to March 2010 (enrolment period) were systematically sampled until the target (n= 250) was reached. Treatment data from enrolment to September 2011 were abstracted from subject charts. Treatment regimens, their frequency of use, and the number of switches (drug replacement/removal/addition) over the study period were calculated. Analyses were stratified by T2DM duration; data for those recentlydiagnosed (< 5 years; n= 29) and with longstanding disease (≥ 20 years; n= 67) are presented. Results: Forty-four percent of subjects were male; at enrolment, mean (SD) age was 61 (13) years, and mean T2DM duration was 11 (8) years. At enrolment, 42% of subjects had received prior insulin treatment (recently-diagnosed: 23%; longstanding disease: 52%). During the study period, the most common regimens were oral combination therapy (41%) and insulin+oral combination therapy (32%). Overall, 44% received any insulin therapy during the study period (recently-diagnosed: 25%; longstanding disease: 54%). By study end, 49% had received any prior insulin therapy (recently-diagnosed: 29%; longstanding disease: 58%). On average, T2DM subjects had 1.3 treatment switches over the period; little variation was seen by T2DM duration. cOnclusiOns: Although the frequency of insulin treatment was lower than reported in other studies from the region, treatment switches are indicative of attempts to improve T2DM control. Novel therapies may improve clinical outcomes among T2DM patients and this study provides valuable baseline data with which to compare the effectiveness of new T2DM treatments in Saudi Arabia.Objectives: SMBG is a core component of diabetes therapy, supporting a safe and effective drug therapy and providing feedback on the impact of diet and lifestyle. In 2014 an Indian guideline on glycemic monitoring was published. This study aims to assess the level of SMBG usage in patients by diabetes therapies. MethOds: Source data for this explorative analysis is the CSD-PDS Diabetes survey covering drug treated patients with diabetes. All 2,250 cases were documented in the 2nd half of 2013. PDS Diabetes is a syndicated research with a fixed representative panel of doctors from larger Indian cities using a standardized documentation of cases. SMBG usage is analyzed by therapeutic subgroups: oral diabetes therapy (OAD 75%), basal supported oral therapy (BOT 9%), conventional insulin therapy (CT 8%), intensive insulin therapy (IIT 5%) and others (3%, excluded). Results: Diabetes type 2: 93%. 1,180 patients (52.4%) have a meter for home-testing. Shares of testers by therapies (OAD/ BOT/...