Patterns and predictors of statin prescription in patients with type 2 diabetes in Germany: Data from the DUTY registry

Aim of the study: The benefit of statins for the prevention of cardiovascular events in patients with type 2 diabetes is well established, but a gap exists between treatment recommendations in guidelines and clinical practice. The aim of the study was to identify patient-related factors predicting the prescription (or not) of a statin in a large cross-sectional data base (DUTY registry).

Methods: Patient-related data were documented at enrolment. Lipoprotein profiles, haemoglobin-A1c, and albumin in urine were determined in each patient. Five-year risk for cardiovascular events was calculated using the risk equation from the Swedish National Diabetes Registry. For bivariate analyses, patients were stratified according to primary and secondary prevention. A multivariable adjusted logistic regression model was constructed to determine which parameters influenced statin prescription in the whole cohort.

Results: A total of 51,640 patients with type 2 diabetes from all across Germany were included. Of these, 34% had established atherosclerotic disease. Overall, only 31.7% of the patients received lipid-lowering drug therapy and 25.5% received a statin. Statin prescription was significantly higher in the secondary compared to the primary prevention group (38.1% [95% CI 37.4% to 38.9%] vs. 18.5% [95% CI 18.0% to 19.0%], respectively). Target values for LDL-C <100mg/dl were achieved in 16.3% (95% CI 15.7% to 16.8%) of patients in the secondary and 12.6% (95% CI 12.2% to 13.0%) in the primary prevention group. In primary prevention the odds for statin prescription increased with estimated cardiovascular risk (OR 1.17 per 5% increase in 5-year risk, 95% CI 1.11 to 1.22). Positive predictors for statin prescription were secondary prevention, hypertension, former smoking, baseline LDL cholesterol, and microalbuminuria. Decreased odds of receiving a statin were observed in older or younger age, older or younger age at first diagnosis of diabetes, and higher or lower body mass index. The model predicted prescription in 70% of the patients correctly.

Conclusions: The vast majority of patients with type 2 diabetes are not receiving statins and are not achieving ADA-recommended LDL-C target levels, both in primary and secondary prevention. The predominant factor determining statin prescription is the patient's estimated cardiovascular risk. The results suggest that although physicians are aware of the general concept of cardiovascular risk, they fail to consistently implement the pertinent guidelines.