Initiation and Persistence to Statin Treatment in Patients with Diabetes Receiving Glucose-Lowering Medications 1997- 2006

Abstract

Aims:Since 2001 guidelines recommend statin treatment in most patients with diabetes. We investigated secular changes in initiation and persistence to statin treatment during a 10-year period in a nationwide cohort of patients initiating glucose-lowering medication (GLM).Methods:All Danish citizens 30 years and older who claimed prescriptions of GLM between 1997 and 2006 were identified from nationwide registers of drug dispensing from pharmacies and hospitalizations, and followed until 2006. Statin treatment was registered if a prescription was claimed during the period. By logistic regression we analyzed factors related to initiation and persistence to statin treatment.Results:In total 128,106 patients were included. In 1997 only 7% of the patients receiving GLM claimed statins within the first year after GLM initiation. Despite increasing statin prescriptions the following years, only 62% were using statins at the end of follow up. The chance of ever receiving statins was lowest if not initiated within 180-days following the first purchase of GLM (OR 0.75, 95% CI 0.74-0.76). A previous myocardial infarction was associated with increased statin treatment (OR 4.51; 95% CI 4.31 - 4.71), while low income was associated with lower use of statins (OR 0.68; 95%CI 0.66-0.72). Between 75-85 % of the patients who initiated statins treatment were persistent to treatment by 2007.Conclusions:In spite of increasing use of statins in diabetes patients over time, many patients remain untreated. Early initiation of statin treatment in diabetic patients and focus on patients with low socioeconomic status is needed to give long-term benefits.

Effects of statin medication on mortality risk associated with type 2 diabetes in older persons: the population-based AGES-Reykjavik Study

“…Data from the UK General Practice Research Database showed an increase in statin use from about 5% in 1996 to 63.5% in women and 71.0% in men in 2005,10 which was associated with HRs of mortality of 0.29 in women and 0.34 in men in the first 2 years following diagnosis of diabetes. Similarly, in Denmark, only 7% of patients receiving glucose-lowering medication also received statins in 1997, but this had increased to 62% in 200711; information on mortality in that study is however lacking. In our cohort of older persons with diabetes, the prevalence of statin medication use was 35% overall.…”

“…This improvement is possibly a result of better adherence to published clinical guidelines, advocating aggressive multifactorial treatment 9. However, many patients with type 2 diabetes are still not receiving treatment with statin medication 10 11…”

Changes in short- and long-term cardiovascular risk of incident diabetes and incident myocardial infarction—a nationwide study

“…Since women tend to have infarctions at an older age than men as well as higher rates of comorbidities, the poorer outcomes in women than in men have largely been attributed to these factors; sex has generally not been interpreted as constituting an independent association [17]. Furthermore, Dominguez et al have shown that women with diabetes are not treated less frequently with statins than their male counterparts [18]. Since the above-mentioned study did not reveal a convincing sex-related difference in statin treatment, the explanation of the higher risk for MI in women following initiation of GLM remains to be explored.…”

Are statin trials in diabetes representative of real-world diabetes care: a population-based study on statin initiators in Finland

“…Only patients under the age of 40 years, with newly diagnosed type 2 diabetes, and without clinical complications or other CVD risk factors, may be withheld from statin therapy 1. In practice, at least 80% of the patients with diabetes who begin taking a statin seem to have no established CVD 8 9…”