Comparative analysis of pharmacotherapy for patients with coronary artery disease and type 2 diabetes at various healthcare stages

Abstract

Aim. To study the features of treatment of patients with various types of coronary artery disease (CAD) and type 2 diabetes (T2D) at various healthcare stages.Material and methods. The comparative clinical study included 412 patients of both sexes with acute and chronic coronary artery disease. Depending on the glycemic status and CAD type, patients were divided into four subgroups: subgroup 1a (n=100, 56,6±0,96 years, male/female 67/33) — with acute CAD and T2D; subgroup 1b (n=106, 58,7±1,01 years, male/female 75/31) — with acute CAD without T2D; subgroup 2a (n=102, 57,9±1,04 years, male/female 72/30) — with chronic CAD and T2D; subgroup 2b (n=104, 60,2±0,9 years, 69/35) — with chronic CAD without T2D. The selection and mean doses of standard and hypoglycemic therapy were analyzed.Results. Initially, 86% and 81% of patients with diabetes in subgroups 1a and 2a adhered to glucose-lowering therapy. Among patients with chronic CAD, more than 1/4 (26,4%) received insulin therapy versus 2% in the group of patients with acute coronary syndrome (ACS) and diabetes. After discharge from hospital, oral hypoglycemic therapy was prescribed to 74% of patients with ACS and 48% of patients with chronic CAD. The prescription of insulin therapy for people with ACS increased 5 times (up to 10% of the total number of patients with ACS and T2D). By the time of hospital admission, 70% and 71,5% of patients with ACS and chronic CAD with diabetes received acetylsalicylic acid as an antiplatelet agent, respectively. During hospitalization, all patients with acute CAD were prescribed dual antiplatelet therapy, as well as triple antiplatelet therapy in the case of atrial fibrillation/flutter. It is noteworthy that in the group of patients with chronic CAD, less than 70% received statins. In patients with chronic CAD and diabetes, this parameter was even lower, amounting to 59,8%. At the outpatient stage, all patients, with the exception of the group with chronic CAD without diabetes, took beta-blockers (up to 65%). In the hospital, the use of beta blockers increased to 95%. During inpatient treatment, angiotensin-converting enzyme inhibitors and sartans were prescribed 1,5-2 times more often than in the prehospital stage.Conclusion. The study indicates insufficient prescription of standard CAD and glucose-lowering therapy. Careful inpatient selection of therapy requires continuity at the outpatient stage.