PMID- 30486824 OWN - NLM STAT- MEDLINE DCOM- 20190124 LR - 20231004 IS - 1472-6963 (Electronic) IS - 1472-6963 (Linking) VI - 18 IP - 1 DP - 2018 Nov 28 TI - Prescription of lipid-lowering medications for patients with type 2 diabetes mellitus and risk-associated LDL cholesterol: a nationwide study of guideline adherence from the Swedish National Diabetes Register. PG - 900 LID - 10.1186/s12913-018-3707-4 [doi] LID - 900 AB - BACKGROUND: Management of type 2 diabetes mellitus (T2DM) encompasses intensive glycaemic control, along with treatment of comorbidities and complications to handle the increased risk of cardiovascular disease (CVD). Improved control of LDL-cholesterol (LDL-C) with lipid-lowering medications is associated with reduced CVD risk in T2DM patients. Thus, treatment guidelines recommend lipid-lowering medications for T2DM patients with LDL-C above risk-associated thresholds. This study aimed to assess healthcare provider adherence to guidelines regarding lipid-lowering medication prescription among T2DM patients and to analyse factors associated with lipid-lowering medication prescription. METHODS: Observations in 2007 - 2014 for T2DM patients age >/= 18 were collected from the Swedish National Diabetes Register. Observations were excluded if they lacked information about LDL-C, lipid-lowering medication prescription or CVD. Observations with established CVD were attributed to secondary prevention; remaining observations were attributed to primary prevention. The analyses included primary and secondary prevention observations with LDL-C above risk-associated thresholds (LDL-C >/= 2.5 mmol/l and LDL-C >/= 1.8 mmol/l respectively). Guideline adherence was analysed as the probability of prescribing lipid-lowering medications using mixed-effect model regression adjusted for potential confounders. Factors associated with prescribing lipid-lowering medications were analysed for patient and healthcare provider characteristics using mixed-effect model regression and odds ratio. RESULTS: A total of 1,204,376 observations from 322,046 patients reported by 1352 healthcare providers were included. Primary prevention accounted for 63%; 52% were men, mean age was 64 and mean LDL-C was 3.4 mmol/l. For secondary prevention, 60% were men, mean age was 72 and mean LDL-C was 2.7 mmol/l. During 2007-2014, guideline adherence ranged from 36 to 47% for primary prevention and 59 to 69% for secondary prevention. In general, concomitant prescription of diabetes medications, antiplatelets and antihypertensives along with smoking and specialised care were associated with higher prescription of lipid-lowering medications. Patients age >/= 80 were associated with lower prescription of lipid-lowering medications. Higher prescription was associated with longer diabetes duration in primary prevention and men in secondary prevention. CONCLUSIONS: Adherence to treatment guidelines levelled off after an initial increase in both prevention groups. Lipid-lowering medication prescription was based on individualised CVD risk. FAU - Karlsson, Sofia Axia AU - Karlsson SA AUID- ORCID: 0000-0002-1896-9587 AD - Department of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, BOX 453, SE-405 30, Gothenburg, Sweden. sofia.karlsson@gu.se. FAU - Franzen, Stefan AU - Franzen S AD - National Diabetes Register, Centre of Registers, Gothenburg, Sweden. FAU - Svensson, Ann-Marie AU - Svensson AM AD - National Diabetes Register, Centre of Registers, Gothenburg, Sweden. FAU - Miftaraj, Mervete AU - Miftaraj M AD - National Diabetes Register, Centre of Registers, Gothenburg, Sweden. FAU - Eliasson, Bjorn AU - Eliasson B AD - Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. FAU - Andersson Sundell, Karolina AU - Andersson Sundell K AD - Department of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, BOX 453, SE-405 30, Gothenburg, Sweden. AD - AstraZeneca AB, Medical Evidence and Observational Research, Molndal, Sweden. LA - eng GR - 2013-0521/Forskningsradet for Halsa, Arbetsliv och Valfard (SE)/ PT - Journal Article DEP - 20181128 PL - England TA - BMC Health Serv Res JT - BMC health services research JID - 101088677 RN - 0 (Antihypertensive Agents) RN - 0 (Blood Glucose) RN - 0 (Cholesterol, LDL) RN - 0 (Hypolipidemic Agents) RN - 0 (Prescription Drugs) SB - IM MH - Aged MH - Antihypertensive Agents/therapeutic use MH - Blood Glucose/metabolism MH - Cholesterol, LDL/metabolism MH - Diabetes Mellitus, Type 2/complications/drug therapy/*prevention & control MH - Diabetic Angiopathies/blood/complications/*prevention & control MH - Female MH - Guideline Adherence MH - Humans MH - Hypercholesterolemia/blood/complications/*prevention & control MH - Hypolipidemic Agents/*therapeutic use MH - Male MH - Middle Aged MH - Practice Guidelines as Topic MH - Prescription Drugs/therapeutic use MH - Primary Prevention MH - Registries MH - Risk Factors MH - Secondary Prevention MH - Sweden PMC - PMC6260691 OTO - NOTNLM OT - Cardiovascular disease prevention OT - Diabetes care OT - Guideline adherence OT - Lipid-lowering medications OT - Type 2 diabetes mellitus COIS- ETHICS APPROVAL AND CONSENT TO PARTICIPATE: The study was approved by the Regional Ethical Review Board at the University of Gothenburg (Reg. no. 1173-16). Individual consent was not required for the present study. However, all patients have given their informed consent to be included in the Swedish National Diabetes Register. CONSENT FOR PUBLICATION: Not applicable. COMPETING INTERESTS: KAS is employed by AstraZeneca. However, the views expressed in this article are her own and not those of AstraZeneca's. All other authors declare that they have no competing interests associated with their contribution to the manuscript. PUBLISHER'S NOTE: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. EDAT- 2018/11/30 06:00 MHDA- 2019/01/25 06:00 PMCR- 2018/11/28 CRDT- 2018/11/30 06:00 PHST- 2018/06/21 00:00 [received] PHST- 2018/11/12 00:00 [accepted] PHST- 2018/11/30 06:00 [entrez] PHST- 2018/11/30 06:00 [pubmed] PHST- 2019/01/25 06:00 [medline] PHST- 2018/11/28 00:00 [pmc-release] AID - 10.1186/s12913-018-3707-4 [pii] AID - 3707 [pii] AID - 10.1186/s12913-018-3707-4 [doi] PST - epublish SO - BMC Health Serv Res. 2018 Nov 28;18(1):900. doi: 10.1186/s12913-018-3707-4.