Trends in the Degree of Control and Treatment of Cardiovascular Risk Factors in People With Type 2 Diabetes in a Primary Care Setting in Catalonia During 2007–2018

Abstract

ObjectiveTo assess the trends in cardiovascular risk factor control and drug therapy from 2007 to 2018 in subjects with type 2 diabetes mellitus (T2DM).Materials and MethodsCross-sectional analysis using yearly clinical data and treatment obtained from the SIDIAP database. Patients aged ≥18 years with a diagnosis of T2DM seen in primary care in Catalonia, Spain. ResultsThe number of T2DM patients increased from 299,855 in 2007 to 394,266 in 2018. We also found an increasing prevalence of cardiovascular disease, heart failure, and chronic kidney disease (from 18.4 to 24.4%, from 4.5 to 7.3%, and from 20.2 to 31.3%, respectively). The achievement of glycemic targets (HbA1c<7%) scarcely changed (54.9% to 55.9%). Major improvements were seen in blood pressure (≤140/90 mmHg: from 55% to 71.8%), and in lipid control (low-density lipoprotein cholesterol <100 mg/dl: 33.4% to 48.4%), especially in people with established cardiovascular disease (48.8 to 69.7%). Simultaneous achievement of all three targets improved from 12.5% to 20.1% in the overall population and from 24.5% to 32.2% in those with cardiovascular disease but plateaued after 2013. There was an increase in the percentage of patients treated with any antidiabetic drug (70.1% to 81.0%), especially metformin (47.7% to 67.7%), and DPP4i (0 to 22.6%). The use of SGLT-2 and GLP-1ra increased over the years, but remained very low in 2018 (5.5% and 2.1% of subjects, respectively). There were also relevant increases in the use of statins (38.0% to 49.2%), renin-angiotensin system (RAS) drugs (52.5% to 57.2%), and beta-blockers (14.3% to 22.7%).ConclusionsDuring the 2007-2018 period, relevant improvements in blood pressure and lipid control occurred, especially in people with cardiovascular disease. Despite the increase in the use of antidiabetic and cardiovascular drugs, the proportion of patients in which the three objectives were simultaneously achieved is still insufficient and plateaued after 2013. The use of antidiabetic drugs with demonstrated cardio renal benefits (SGLT-2 and GLP-1ra) increased over the years, but their use remained quite low.

Trends of Non-Traumatic Lower-Extremity Amputation and Type 2 Diabetes: Spain, 2001–2019

“…A remarkable result of our investigation is that among women and men with T2DM who underwent a LEAs, the prevalence of cardiovascular risk factors and chronic conditions has increased overtime. A recent study conducted in Spain that analyzed the changes in the health profile of people with T2DM from 2007 to 2018 agreed with us, finding an increment in the prevalence of hypertension, dyslipidemia, heart failure, and chronic kidney disease [ 52 ]. Suggested explanations for this increase include the aging population, improvement in registration, lowering the limit for hypercholesterolemia diagnosis and the improvement in the quality of care for people with T2DM, which would result in earlier detection of risk factors and chronic conditions and therefore reduce the prevalence [ 52 , 53 ].…”

Potential Risk of Overtreatment in Patients with Type 2 Diabetes Aged 75 Years or Older: Data from a Population Database in Catalonia, Spain

“…However, in several studies around the world, the prescription of DPP4i progressively outperformed sulfonylureas in older adults [ 26 , 33 , 37 , 38 ]. This could explain the progressive decrease in sulfonylureas use observed in our database from 2007 to 2018 [ 28 ].…”

“…This was a cross-sectional study using the SIDIAP database (Information System for the Development of Research in Primary Care) ( , accessed on 7 August 2022) [ 28 ], which contains pseudo-anonymized longitudinal patient information obtained from the electronic health records (EHR) of patients attended by 286 primary care teams at the Institut Català de la Salut (Catalan Health Institute), which covered 74% of the total population in Catalonia in 2016 [ 29 ]. In brief, SIDIAP contains sociodemographic characteristics, morbidity (International Classification of Diseases, Tenth Revision; ICD-10), clinical and lifestyle variables, specialist referrals, laboratory tests, and treatments (prescription and pharmacy invoicing data) since 2006.…”

“…Several reports on the management and treatment of patients with T2DM in Catalonia (Spain), based on the SIDIAP population database, have consistently shown that older adults have better control than other age subgroups [ 27 , 28 , 29 , 30 ]. For instance, 59.2% of T2DM patients over 75 had HbA1c < 7% and 37.7% HbA1c < 6.5% in 2016 [ 30 ], which leads us to suspect the existence of potential overtreatment.…”

Comorbid autoimmune diseases and burden of diabetes-related complications in patients with type 1 diabetes from a Mediterranean area

“…It also includes medications dispensed in pharmacy offices and incorporates data of hospital discharges obtained from the Basic Minimum Set of Data (BMSD). The SIDIAP database has previously been used to conduct several observational studies that evaluate clinical characteristics and outcomes in Type 1 [19,21] and Type 2 [22,23] diabetes in Catalonia.…”