Dyslipidemia: The untreated metabolic dysfunction in people with type 2 diabetes in Latin America. ARETAEUS study outcomes

Abstract

ObjectiveTo assess oral antihyperglycemic agents (OAHA) and/or statin treatment initiation in patients with type 2 diabetes (T2D) and time from diagnosis to both types of treatment initiation and intensification.Research design and methodsWe reviewed 662 retrospective medical records of patients with T2D diagnosed by 31 general practitioner or specialist sites across Mexico, Argentina, and Brazil. Demographic and clinical information was abstracted from patients’ medical records and summarized using descriptive statistics. Between-group differences were assessed with Student’s t-test for continuous variables and Fisher’s exact test for categorical variables. The starting time of each therapy (OAHA and statins, separately) was assessed using Kaplan-Meier estimates.ResultsAt diagnosis, patients’ mean age was 53 years; 44% had hypertension, 42% were obese, and 23% had dyslipidemia. During the 2-year follow-up, 95% of patients received OAHAs but only 29% of those eligible for statins received this prescription. Mean ± SD and median (Q1, Q3) time to first OAHA was 59 ± 141 days and 1 (1, 31) day, respectively, and 230 ± 232 days and 132 (30, 406) days, respectively, for a statin. During follow-up, 51–53% of patients with HbA1c/FPG values above target did not intensify hyperglycemia treatment.ConclusionDyslipidemia treatment in patients with T2D was delayed despite its known deleterious effect on atherosclerosis development and β-cell mass/function. Anti-hyperglycemic treatment was not intensified when targets were not attained. This prescriptive inertia needs to be corrected because attainment of HbA1c treatment goals becomes more difficult, favoring the development of diabetes complications.

Clinical inertia is the enemy of therapeutic success in the management of diabetes and its complications: a narrative literature review

“…Percentage of therapy intensification in patients with HBA1c > 8% (addition of an oral hypoglycemic agent or dosage increase for an existing therapy or initiation of insulin treatment) [33,83] Percentage of therapy intensification in patients with HBA1c > 7% [84] Percentage of initiation of insulin treatment in patients with HBa1c > 9% [42] Average time elapsed between type 2 diabetes diagnosis and initiation of insulin treatment in patients with non-target HBa1c [42] Percentage of patients with HBa1c > 7% undergoing basal insulin treatment for 180 days and subjected to the intensification of insulin therapy [43] Difference between the percentage of outpatient visits in which sBP was higher than the target minus the percentage of outpatient visits in which a modification of anti-hypertensive treatment was implemented, either type or dose of treatment, divided by the number of eligible visits. The resulting value is multiplied by the average difference between sBP as measured in all visits and the target value of sBP [85] Percentage of patients with non-target levels of LDL cholesterol and treated with statins, divided by the total number of eligible patients [86] Time (days) elapsed before a therapeutic intervention subsequent to sub-optimal lab test results [87] Percentage of healthcare professionals who prescribe the initiation of insulin therapy to patients with type 2 diabetes and HbA1c at the recommended threshold of 7-7.9% [42] Number of patients without therapy intensification, divided by the total number of patients with HbA1c ≥ 7%, multiplied by 100 [52] Time spent with poor glycemic control (HbA1c 7%, > 7,5%, > 8%) in patients with type 2 diabetes treated with DPP-4i/SGLT-2i until the intensification of treatment with insulin/GLP-1RA [88] Percentage of patients lacking therapy intensification within 180 days from metformin failure [89] through a methodology equated with the use of outcome indicators (Table 3).…”

BrazIliaN Type 1 & 2 DiabetEs Disease Registry (BINDER): longitudinal, real-world study of diabetes mellitus control in Brazil

“…This rate is surprisingly high when compared with the results of other studies. The ARATEUS study evaluated the medical charts of 662 patients with T2DM and observed that in the first 2 years of follow-up, only 29% of patients were in use of statins for the management of the dyslipidemia ( 20 ).…”

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

“…In 2019, the ARETAEUS study results showed a delayed dyslipidemia treatment in a large cohort of T2DM patients, despite the presence of high LDL-cholesterol levels, either before or after the diagnosis of T2DM. Moreover, the antidiabetic treatment was not intensified when the glycemic targets were not reached [ 107 ]. The analysis of the indicators of therapeutic inertia using data from the Annals of the Associazione Medici Diabetologi , involving more than 300 diabetes centers throughout Italy, showed that between 2011 and 2018 the proportion of subjects with glycated hemoglobin >9% not treated with insulin had fallen from 40.5% to 28.2%, while there was no significant change in the ratio of subjects not treated with statins despite elevated LDL cholesterol levels (from 57.5% to 52.4%).…”