Patients with type 2 diabetes (T2D) who have had a cardiovascular (CV) event are not adequately prescribed glucose-lowering medications that might prevent subsequent CV events. Instead, these patients tend to receive drugs to control risk factors rather than newer antidiabetic medications with known CV benefits, according to study results published in the Journal of the American Heart Association.
Findings from CV outcome trials have shown that newer glucose-lowering medications can protect against further CV events in patients with T2D who have established CV disease. Researchers sought to evaluate glucose-lowering medication prescription rates in patients with T2D with and without a history of CV events.
A total of 563 patients with T2D who had a recorded CV event (cases) and 497 patients with T2D without any CV event (controls) were matched for age (mean age, 69 years), sex (73% men), diabetes duration (mean duration, 14 years), baseline hemoglobin A1c (HbA1c) (mean, 7.7%), kidney function, and follow-up time. In addition, patients’ prescribed therapies were compared at baseline and follow-up. Patients with a recorded CV event had a significantly higher baseline prevalence of ischemic heart disease.
After a median follow-up of 9.5 months, there was a significantly greater increase in prescription rates for beta-blockers, loop diuretics, and dual antiplatelet therapy in case patients than control patients. In patients who received glucose-lowering medications, metformin prescription rates were reduced in the case group (-5.3%) compared with the control group, with a significant between-group difference even after adjustment for lipid profile (-4.7%; P =.041).
Overall, the number of different classes of glucose-lowering medications prescribed per patient remained mostly unchanged in case patients, whereas there was a slight increase in control patients (P =.954 vs P =.007). Average HbA1c decreased slightly in the control group but there was no significant change in the case group. Improvements in systolic blood pressure and cholesterol levels were greater in the case vs the control group.
Study limitations included potential underreporting of incident CV events because of the study’s retrospective design.
“In this analysis of therapeutic appropriateness in the real world, we found that occurrence of a [CV event] in patients with [T2D] prompted marginal changes in the prescription of [glucose-lowering medications], with no increase in drugs provided with protective cardiovascular effects and no decrease in drugs with a high risk of hypoglycemia,” wrote the researchers.
“The present study advocates a call to action for stakeholders involved in diabetes mellitus care… We acknowledge that such a paradigm shift, bestowed by national and international guidelines, is still under way, and we will resurvey the situation in the future to monitor this unmet need.”
Fadini GP, Frison V, Simioni N, et al. Changes in the prescription of glucose-lowering medications in patients with type 2 diabetes mellitus after a cardiovascular event: a call to action from the DATAFILE study. J Am Heart Assoc. 2019;8:e012244.