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Patients with Type 2 Diabetes on Dual Therapy Less Likely to Comply with Statin Therapy

Nov 24, 2010

Persistence with statin therapy trails persistence with oral antihyperglycemic therapy in patients with Type 2 diabetes who are treated with statins and oral antihyperglycemic agents simultaneously.

The study identifies a role for an integrated approach to minimize the “persistence gap” in patients with Type 2 diabetes. The researchers suggest that such an approach might lessen cardiovascular risks in this population.

Qiaoyi Zhang, MD, PhD, Global Health Outcomes, Merck Sharp & Dohme Corporation, Whitehouse Station, New Jersey, and colleagues used a US commercial-claims database to compare the persistence between statin and oral antihyperglycemic use in patients with Type 2 diabetes who received these therapies concomitantly.

“Patients with Type 2 diabetes are at increased risk for microvascular and macrovascular complications,” Dr. Zhang said on November 14. Glycemic control has shown benefits on microvascular complications, she added. Statin therapy is recommended for most Type 2 diabetes, regardless of the patient’s lipid level, to reduce increased cardiovascular risk.

Persistence with both antihyperglycemic and statin therapies is critical to achieve the long-term clinical benefits of these therapies on glycemic control, dyslipidemia, and vascular outcomes, said Dr. Zhang.

The study consisted of 52,414 patients who had been given both a statin and an oral antidiabetes drug prescription on the same date in 2006. Patient medical records were evaluated for 1 year before (baseline) and 2 years after (follow-up) the index date. Statin therapy and the oral antihyperglycemic regimen were assessed separate separately. The 2-year medication possession ratio (MPR) between statin and oral antihyperglycemic therapies was compared.

The researchers found that the 2-year MPR was 70% for statin and 78% for the oral antihyperglycemic regimen. Overall, 28% of patients remained on statins at the end of the 2-year follow-up, and 42% of patients remained on their oral antihyperglycemic agent.

The median time to discontinuation was shorter with statin therapy than with oral antihyperglycemic therapy (285 vs. 485 days, P <.001). The study also found that patients with Type 2 diabetes were 47% more likely to stop statin therapy than oral antihyperglycemic therapy (adjusted hazards ratio, 1.47; 95% confidence interval, 1.45-1.50). Actual patient compliance with the therapies was not recorded in the database, which may be a study limitation, Dr. Zhang said. Also, medical records were determined based on the ICD-9 codes on their medical insurance claims. Presented at AHA meeting: Patients With Type 2 Diabetes Have Worse Persistency With Statin Therapy Than With Oral Antihyperglycemic Regimen Abstract 18530