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

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.

Efficacy, Safety, Cost, and Clinical Outcomes After the Switch to Generic Rosuvastatin Compared with Consistent Brand-Name Atorvastatin Treatment.

Background: The efficacy, safety, and clinical outcomes for patients switch to generic rosuvastatin, compared with patients taking other brand-name atorvastatin, is unclear. Method: We retrospectively collected electronic medical records from January 1, 2013, to December 31, 2020, of patients who switched medication, because of hospital policy, from brand-name to generic rosuvastatin after March 14, 2018. we only considered patients who had taken the medication at least 1 year prior to and 1 year after that date. We also collected records of patients who consistently used brand-name atorvastatin during the same period. The efficacy of lipid control, potential adverse effects, clinical outcomes of major cardiovascular events (MACE), and medical expenses were compared between the 2 groups. Propensity score matching (PSM) was conducted to balance potential cofounders. Result: After 1:1 PSM, 592 patients were enrolled in the rosuvastatin and atorvastatin groups, and no significant difference was observed in their total cholesterol (TC) level difference (−4.38 ± 23.0 vs. −3.72 ± 26.95 mg/dL, P = 0.702), low-density lipoprotein (LDL-C) (−2.38 ± 19.89 vs. −2.42 ± 23.63 mg/dL, P = 0.976), or glycated hemoglobin (−0.05% ± 0.7% vs. −0.08% ± 0.76%, P = 0.543). No significant differences were noted in their cumulative MACE (2.70% vs. 3.89%, log-rank P = 0.265) after the switch date, and each person in the generic group had a 16% average reduction in their medical expenses. Conclusion: Switching to generic rosuvastatin led to comparable lipid-lowering efficacy, safety, and clinical outcomes and fewer medical expenses compared with consistently using brand-name atorvastatin.

Metformin extended-release versus metformin immediate-release for adults with type 2 diabetes mellitus: a systematic review and meta-analysis of randomized controlled trials

This systematic review aimed to compare the efficacy and tolerability of metformin extended-release (MXR) and the conventional metformin immediate-release (MIR) in adults with type 2 diabetes mellitus (T2DM). PubMed, the Cochrane Library and ClinicalTrials.gov, from database inception to 15 October 2020, and other sources were searched for randomized controlled trials (RCTs) that compared equal daily doses of MXR and MIR in adults with T2DM. Random-effects model meta-analysis was performed to obtain pooled mean difference (MD) of change from baseline for continuous outcomes (glycemic and serum lipid control and anthropometrics) and risk ratio (RR) for dichotomous outcomes (gastrointestinal and serious adverse events). Statistical analysis involving 9 published RCTs with 2609 subjects revealed that MIR was associated with better HbA1c lowering (MD 0.09% [95% confidence interval, 0.02%, 0.17%]) and serum lipid control except LDL-C lowering, while MXR reduced only the cumulative incidence of dyspepsia (RR 0.58 [0.34, 0.98]). MXR and MIR were similar in all other considered outcomes. The use of MXR over MIR among adults with T2DM was associated with statistically worse but likely clinically insignificant HbA1c lowering, similar plasma glucose lowering, and minimal improvement of metformin intolerance. This information may guide patient-physician discussions in choosing between the two formulations.

Efficacy, Safety, Cost, and Clinical Outcomes After the Switch to Generic Rosuvastatin Compared with Consistent Brand-Name Atorvastatin Treatment.

Background: The efficacy, safety, and clinical outcomes for patients switch to generic rosuvastatin, compared with patients taking other brand-name atorvastatin, is unclear. Method: We retrospectively collected electronic medical records from January 1, 2013, to December 31, 2020, of patients who switched medication, because of hospital policy, from brand-name to generic rosuvastatin after March 14, 2018. we only considered patients who had taken the medication at least 1 year prior to and 1 year after that date. We also collected records of patients who consistently used brand-name atorvastatin during the same period. The efficacy of lipid control, potential adverse effects, clinical outcomes of major cardiovascular events (MACE), and medical expenses were compared between the 2 groups. Propensity score matching (PSM) was conducted to balance potential cofounders. Result: After 1:1 PSM, 592 patients were enrolled in the rosuvastatin and atorvastatin groups, and no significant difference was observed in their total cholesterol (TC) level difference (−4.38 ± 23.0 vs. −3.72 ± 26.95 mg/dL, P = 0.702), low-density lipoprotein (LDL-C) (−2.38 ± 19.89 vs. −2.42 ± 23.63 mg/dL, P = 0.976), or glycated hemoglobin (−0.05% ± 0.7% vs. −0.08% ± 0.76%, P = 0.543). No significant differences were noted in their cumulative MACE (2.70% vs. 3.89%, log-rank P = 0.265) after the switch date, and each person in the generic group had a 16% average reduction in their medical expenses. Conclusion: Switching to generic rosuvastatin led to comparable lipid-lowering efficacy, safety, and clinical outcomes and fewer medical expenses compared with consistently using brand-name atorvastatin.

Relationship between Dietary Habits and Control of Lipid Profiles in Patients with Dyslipidemia Using Pravastatin

We investigated the association between dietary habits, evaluated using the modified Mini Dietary Assessment Index for Koreans (MDA), and lipid control among patients aged ≥20 years who had used pravastatin for dyslipidemia for 6 months. Participants were administered questionnaires regarding sociodemographic characteristics and lifestyle factors. Odds ratios and 95% confidence intervals for the control of low-density lipoprotein cholesterol (LDL-C), triglyceride (TG), and total cholesterol (TC) at 6 months for each category of the modified MDA items were calculated through multivariate logistic regression analysis. The odds for controlled LDL-C was higher among those who consumed cholesterol-rich foods <1 time/week (3.27, 1.25–8.57) than for those who did so ≥4 times/week. The odds for controlled TG was higher among those who always consumed dairy products (2.96, 1.36–6.44), ate protein-rich foods three times/day (2.94, 1.06–8.10), and had a regular eating schedule (3.02, 1.30–7.00) than among those who did not have any of these. The odds for controlled TC was higher among those with a regular eating schedule (3.47, 1.55–7.76) than among their counterparts. Patients with dyslipidemia should consume less cholesterols, consume more dairy and protein-rich foods, and follow a regular eating schedule to control lipid profiles.

The frequency and profile of lipid lowering treatment in a contemporary Russian population

Background Despite of guidelines for management of dyslipidemias (DLP) and the availability of effective and safe lipid lowering drugs (LLD), about one half of CVD patients do not reach the target lipid levels. The knowledge on DLP management in Russian population is limited. Objective To analyze the frequency and profile of LLD therapy in subjects with DLP and cardiometabolic diseases in a contemporary Russian population. Methods A random population sample of men and women 55–84 years old (n=3898) was examined in 2015–17 in the Russian arm of the HAPIEE project. A composite dysmetabolic group included DLP (total cholesterol, TC ≥5 mmo/l or low-density lipoprotein cholesterol, LDLC ≥3 mmol/l or triglycerides, TG ≥1.7 mmol/l) and/or coronary heart disease (CHD) and/or diabetes mellitus type 2 (DM2). Regular medication intake for 12 months was coded by ATC. Results In studied population sample 88% of subjects had dysmetabolic disorders (DLP - 83.1%, CHD - 14.9%, DM2- 20.8%); among them 32.8% subjects received LLD therapy (21.2% in men vs. 39.4% in women, p&lt;0.001) and 17.1% did not report the status of LLD receiving. The frequency of LLD use in CHD group was 48,3%, in DM2 – 35,0%, in DLP – 29.4%. Among named LLD, statins were predominantly used (98%). Lipids control was achieved among subjects with CHD in 18.3% (37.9% among those receiving LLD); among DM2 - in 9.0% (25.6%); among DLP without CHD or DM2 – in 7.3% (24.8%). Conclusion In an urban population sample aged 55–84 examined in 2015–17, more than one half of subjects with dysmetabolic disorders (CHD, DM2, DLP) did not receive LLD. Among those receiving lipid-lowering therapy, the lipid control was achieved in about 40% of participants with CHD, and in every forth participant with DM2 or DLP. The lack of lipid control is likely to contribute high rate of atherosclerotic CVD in studied population. FUNDunding Acknowledgement Type of funding sources: Foundation. Main funding source(s): Russian Foundation of Basic Research; Russian Academy of Sciences

ASSESSMENT OF THE USE OF DRUG TREATMENT OF DYSLIPIDEMIA AT MILITARY HOSPITAL 105

Dyslipidemia characteristics of outpatients with dyslipidemia for the first time, characteristics of drug use, and effectiveness in controlling dyslipidemia indexes after 3 months of treatment at Military Hospital 105 were studied. A crosssectional, retrospective descriptive study was investigated on adult outpatients who were diagnosed with dyslipidemia for the first time, examined and treated as outpatients at the hospital, and monitored for effectiveness in blood lipid control for 3 months after starting treatment. The decision to use the drug at the start of the study and the achievement of treatment goals at the time points were analyzed based on the ESC\EAS 2019 guidelines for treating DL. The majority of patients were aged > 45 years (80.5%), the most common group of patients was aged 46 - 59 (43.7%). The number of patients with comorbidities accounted for 62.8%. 87% of patients had mixed dyslipidemia, 54.8% of patients were in the group with high and very high cardiovascular risk. 93.5% of patients needed to start treatment with drugs based on LDL-C index at the time of treatment initiation. The majority of patients used monotherapy regimens, in which, Statins were used the most in the study sample with the rate of 95.3% in the initial treatment regimen. 70.4% of patients had an inappropriate decision to initiate treatment, of which the most common was the decision to use statins with insufficient dosage in patients (45.1%). Only 28% of patients reached their LDL-C goal after 3 months of treatment. From the high percentage of patients who did not reach the treatment goal in the study sample, it is necessary to consider using stronger statin therapy, higher dose statin, or using another treatment regimen for patients.