Utilization of statins and LDL-cholesterol target attainment in Turkish patients with type 2 diabetes - a nationwide cross-sectional study (TEMD dyslipidemia study)

• Published in: Lipids in health and disease Vol. 19; no. 1; pp. 1 - 237
• Main Authors: Bayram, Fahri, Sonmez, Alper, Sabuncu, Tevfik, Dizdar, Oguzhan Sitki, Gurkan, Eren, Carlioglu, Ayse Kargili, Agbaht, Kemal, Ozdemir, Didem, Demirci, Ibrahim, Barcin, Cem, Salman, Serpil, Tetiker, Tamer, Balci, Mustafa Kemal, Ersoy, Canan, Yumuk, Volkan, Toth, Peter P, Satman, Ilhan, Guldiken, Sibel, Ayturk, Semra, Yilmaz, Murat, Asik, Mehmet, Dinccag, Nevin, Turker, Fulya, Idiz, Cemile, Hacisahinogullari, Hulya, Bagdemir, Elif, Yildiz, Busra, Haliloglu, Ozlem, Sancak, Seda, Ozsari, Levent, Cagiltay, Eylem, Deyneli, Oguzhan, Imre, Eren, Gonen, Sait, Boysan, S. Nur, Altuntas, Yuksel, Piskinpasa, Hamide, Aydin, Hasan, Imamoglu, Sazi, Gul, Ozen Oz, Kiyici, Sinem Kucuksarac, Cetinarslan, Berrin, Selek, Alev, Dogru, Teoman, Kirik, Ali, Efe, Belgin, Kaya, Ahmet, Cordan, Ilker, Baldane, Suleyman, Kirac, Cem Onur, Capa, Zehra, Cesur, Mustafa, Corapcioglu, Demet, Yildiz, Okan Bulent, Sendur, Suleyman Nahit, Cakir, Bekir, Kutlu, Mustafa, Tutuncu, Neslihan Bascil, Bozkus, Yusuf, Cakal, Erman, Demirbas, Berrin, Ertek, Sibel, Altay, Mustafa, Dagdeviren, Murat, Abedi, Amir Hossein, Cetinkalp, Sevki, Ozisik, Hatice, Oruk, Guzide Gonca, Yener, Serkan, Saydam, Basak Ozgen, Unubol, Mustafa, Yaylali, Guzin Fidan, Topsakal, Senay, Akbaba, Gulhan, Aslan, Ibrahim, Dalkiran, Sefika, Akbay, Esen, Gul, Kamile, Yilmaz, Muge Ozsan, Bozkirli, Emre, Altuntas, Seher Cetinkaya, Atmaca, Aysegul, DurmuÅ, Elif Tutku, Mete, Turkan, Kucukler, Ferit Kerim, Dikbas, Oguz, Akin, Safak, Nuhoglu, Irfan, Onder Ersoz Halil Onder Ersoz, Halil, Bayraktaroglu, Taner, Sisman, Pinar, Sahin, Ibrahim, Cetin, Sedat, Capoglu, Ilyas, Akbas, Emin Murat, Eren, Mehmet Ali, Tuzcu, Alpaslan Kemal, Pekkolay, Zafer, Ozkaya, Mesut, Araz, Mustafa
• Format: Journal Article
• Language: English
• Published: London BioMed Central Ltd 11.11.2020; BioMed Central; BMC
• Subjects: Blood pressure; Body mass index; Cardiovascular disease; Cholesterol; Cross-sectional studies; Data collection; Diabetes; Diabetes mellitus (non-insulin dependent); Diabetic nephropathy; Drug therapy; Dyslipidemia; Dyslipidemias; Exercise; Glucose; Health aspects; Hypertension; Hypoglycemia; Laboratories; LDL cholesterol; Lipid-lowering treatments; Lipids; Low density lipoprotein; Low-density lipoprotein cholesterol target attainment; Metabolic disorders; Nephropathy; Obesity; Patient outcomes; Physical fitness; Physicians’ attitudes; Questionnaires; Risk factors; Sociodemographics; Statin cessation; Statins; Triglycerides; Type 2 diabetes; Type 2 diabetes mellitus; Turkey
• ISSN: 1476-511X; 1476-511X
• DOI: 10.1186/s12944-020-01408-2

Abstract Background Attaining acceptable levels of LDL Cholesterol (LDL-C) significantly improves cardiovascular (CV) outcomes in patients with type 2 diabetes mellitus (T2DM). The LDL-C target attainment and the characteristics of patients attaining these targets were investigated in this study. Furthermore, the reasons for not choosing statins and the physicians’ attitudes on the treatment of diabetic dyslipidemia were also examined. Methods A nationwide, cross-sectional survey was conducted in tertiary centers for diabetes management. Adult patients with T2DM, who were under follow-up for at least a year in outpatient clinics, were consecutively enrolled for the study. LDL-C goals were defined as below 70 mg/dL for patients with macrovascular complications or diabetic nephropathy, and below 100 mg/dL for other patients. Data about lipid-lowering medications were self-reported. Results A total of 4504 patients (female: 58.6%) were enrolled for the study. The mean HbA1c and diabetes duration was 7.73 ± 1.74% and 10.9 ± 7.5 years, respectively. The need for statin treatment was 94.9% ( n  = 4262); however, only 42.4% ( n  = 1807) of these patients were under treatment, and only 24.8% ( n  = 448) of these patients achieved LDL-C targets. The main reason for statin discontinuation was negative media coverage (87.5%), while only a minority of patients (12.5%) mentioned side effects. Physicians initiated lipid-lowering therapy in only 20.3% of patients with high LDL-C levels. It was observed that the female gender was a significant independent predictor of not attaining LDL-C goals (OR: 0.70, 95% CI: 0.59–0.83). Conclusions Less than 50 % of patients with T2DM who need statins were under treatment, and only a quarter of them attained their LDL-C targets. There exists a significant gap between the guideline recommendations and the real-world evidence in the treatment of dyslipidemia in T2DM.