1. Utilization of statins and LDL-cholesterol target attainment in Turkish patients with type 2 diabetes-a nationwide cross-sectional study (TEMD dyslipidemia study)
- Author
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Fahri Bayram, Alper Sonmez, Cem Haymana, Tevfik Sabuncu, Oguzhan Sitki Dizdar, Eren Gurkan, Ayse Kargili Carlioglu, Kemal Agbaht, Didem Ozdemir, Ibrahim Demirci, Cem Barcin, Serpil Salman, Tamer Tetiker, Mustafa Kemal Balci, Nur Kebapci, Canan Ersoy, Volkan Yumuk, Peter P. Toth, Ilhan Satman, TEMD Study Group, İÜC, Cerrahpaşa Tıp Fakültesi, Dahili Tıp Bilimleri Bölümü, Bursa Uludağ Üniversitesi/Tıp Fakültesi/Endokrinoloji ve Metabolizma Anabilim Dalı., Ersoy, Canan, and AAH-8861-2021
- Subjects
Male ,Complications ,Glycated Hemoglobin A ,Biochemistry & molecular biology ,Tertiare care centers ,Endocrinology, Diabetes and Metabolism ,Clinical Biochemistry ,Cardiovascular Disease ,Alirocumab ,Familial Hypercholesterolemia ,Type 2 diabetes ,030204 cardiovascular system & hematology ,Turkey (republic) ,hydroxymethylglutaryl coenzyme A reductase inhibitor ,low density lipoprotein cholesterol ,Tertiary Care Centers ,0302 clinical medicine ,Endocrinology ,Surveys and Questionnaires ,middle aged ,Outpatient clinic ,Disease ,genetics ,030212 general & internal medicine ,lcsh:RC620-627 ,hemoglobin A1c ,Physician inertia ,Lipid-modifying theraphy ,anthropometry ,attitudes ,non insulin dependent diabetes mellitus ,adult ,Physicians’ ,Management ,lcsh:Nutritional diseases. Deficiency diseases ,Low-density lipoprotein cholesterol target attainment ,female ,Lipid-lowering treatments ,lipids (amino acids, peptides, and proteins) ,tertiary care center ,drug utilization ,Statin cessation ,medicine.medical_specialty ,Cardiovascular-risk ,Statin ,medicine.drug_class ,self report ,Clinical nutrition ,Guidelines ,Gender-differences ,Article ,03 medical and health sciences ,Diabetes management ,blood ,Internal medicine ,Type 2 diabetes mellitus ,medicine ,cross-sectional study ,follow up ,Humans ,human ,Nutrition & dietetics ,glycosylated hemoglobin ,Aged ,Dyslipidemias ,Glycated Hemoglobin ,business.industry ,Research ,diabetic nephropathy ,questionnaire ,Biochemistry (medical) ,dyslipidemia ,Type 2 Diabetes Mellitus ,nutritional and metabolic diseases ,outpatient department ,Cholesterol, LDL ,Goal attainment ,medicine.disease ,major clinical study ,Discontinuation ,Physicians’ ,Cross-Sectional Studies ,Density-lipoprotein cholesterol ,Real-world ,Diabetes Mellitus, Type 2 ,Dyslipidemia ,Physicians’ attitudes ,Attitudes ,Turk (people) ,hemoglobin A1c protein, human ,disease duration ,Hydroxymethylglutaryl-CoA Reductase Inhibitors ,business - 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. © 2020, The Author(s)., Ankara Universitesi; University of Health Sciences Lahore, UHS, The physicians and nurses in every TEMD study center who took role in recruitment of patients are acknowledged as the collaborators of TEMD Dyslipidemia Study (see supplementary data). The authors also appreciatively acknowledge the critical reviews and contributions of Professor Meral Kayikcioglu and Professor Ilker Tasci during the preparation of the manuscript. Consortium members and affiliations TEMD Study Group: Sibel Guldiken19, Semra Ayturk19, Murat Yilmaz20, Mehmet Asik21, Nevin Dinccag18, Ramazan Cakmak18, Fulya Turker18, Cemile Idiz18, Hulya Hacisahinogullari18, Elif Bagdemir18, Busra Yildiz18, Ozlem Haliloglu16, Seda Sancak22, Levent Ozsari23, Eylem Cagiltay23, Oguzhan Deyneli24, Eren Imre24, Sait Gonen25, S Nur Boysan19, Yuksel Altuntas26, Feyza Yener Ozturk26, Meral Mert27, Hamide Piskinpasa27, Hasan Aydin28, Sazi Imamoglu29, Ozen Oz Gul25, Sinem Kucuksarac Kiyici30, Berrin Cetinarslan31, Alev Selek31, Teoman Dogru32, Ali Kirik32, Belgin Efe14, Ahmet Kaya33, Ilker Cordan33, Suleyman Baldane34, Cem Onur Kirac34, Zehra Capa3, Mustafa Cesur35, Ilhan Yetkin36, Demet Corapcioglu37, Sule Canlar37, Okan Bulent Yildiz38, Suleyman Nahit Sendur38, Bekir Cakir9, Ahmet Corakci39, Mustafa Kutlu40, Neslihan Bascil Tutuncu41, Yusuf Bozkus41, Erman Cakal42, Berrin Demirbas43, Sibel Ertek44, Mustafa Altay45, Murat Dagdeviren45, Amir Hossein Abedi1, Sevki Cetinkalp46, Hatice Ozisik46, Guzide Gonca Oruk47, Serkan Yener48, Basak Ozgen Saydam48, Engin Guney49, Mustafa Unubol49, Guzin Fidan Yaylali50, Senay Topsakal50, Zeliha Hekimsoy51, Gulhan Akbaba52, Ibrahim Aslan53, Sefika Dalkiran13, Esen Akbay54, Kamile Gul55, Muge Ozsan Yilmaz6, Emre Bozkirli56, Seher Cetinkaya Altuntas12, Aysegul Atmaca57, Elif Tutku Durmuş57, Turkan Mete58, Faruk Kutluturk59, Ferit Kerim Kucukler60, Oguz Dikbas61, Safak Akin62, Irfan Nuhoglu63, Halil Onder Ersoz63, Taner Bayraktaroglu64, Pınar Sisman65, Ibrahim Sahin66, Sedat Cetin66, Ilyas Capoglu67, Emin Murat Akbas67, Rıfkı Ucler68, Mehmet Ali Eren4, Alpaslan Kemal Tuzcu69, Zafer Pekkolay69, Mesut Ozkaya70, Mustafa Araz71.19Trakya University, School of Medicine, Department of Endocrinology and Metabolism, Turkey.20Corlu REYAP Private Hospital, Department of Endocrinology and Metabolism, Turkey.21Canakkale 18 March University, School of Medicine, Department of Endocrinology and Metabolism, Turkey.22University of Health Sciences, School of Medicine, Fatih Sultan Mehmet Training and Research Hospital, Department of Endocrinology and Metabolism, Turkey.23University of Health Sciences, School of Medicine, Sultanabdulhamit Training and Research Hospital, Department of Endocrinology and Metabolism, Turkey.24Marmara University, School of Medicine, Department of Endocrinology and Metabolism, Turkey.25Istanbul Science University, School of Medicine, Department of Endocrinology and Metabolism, Turkey.26University of Health Sciences, School of Medicine, Sisli Hamidiye Etfal Training and Research Hospital, Department of Endocrinology and Metabolism, Turkey.27University of Health Sciences, School of Medicine, İstanbul Bakırkoy Dr. Sadi Konuk Training and Research Hospital, Department of Endocrinology and Metabolism, Turkey.28Yeditepe University, School of Medicine, Department of Endocrinology and Metabolism, Turkey.29Private Office.30University of Health Sciences, School of Medicine, Bursa Sevket Yılmaz Training and Research Hospital, Department of Endocrinology and Metabolism, Turkey.31Kocaeli University, School of Medicine, Department of Endocrinology and Metabolism, Turkey.32Balikesir University, School of Medicine, Department of Internal Medicine, Turkey.33Necmettin Erbakan University, School of Medicine, Department of Endocrinology and Metabolism, Turkey.34Selcuk University, School of Medicine, Department of Endocrinology and Metabolism, Turkey.35Private Guven Hospital, Department of Endocrinology and Metabolism, Turkey.36Gazi University, School of Medicine, Department of Endocrinology and Metabolism, Turkey.37Ankara University, School of Medicine, Department of Endocrinology and Metabolism, Turkey.38Hacettepe University, School of Medicine, Department of Endocrinology and Metabolism, Turkey.39Ufuk University, School of Medicine, Department of Endocrinology and Metabolism, Turkey.40Private Bayındır Hospital, Department of Endocrinology and Metabolism, Turkey.41Baskent University, School of Medicine, Department of Endocrinology and Metabolism, Turkey.42University of Health Sciences, School of Medicine, Diskapi Yildirim Beyazit Training and Research Hospital, Department of Endocrinology and Metabolism, Turkey.43TOBB University, School of Medicine, Department of Endocrinology and Metabolism, Turkey.44Private Memorial Hospital, Department of Endocrinology and Metabolism, Turkey.45University of Health Sciences, School of Medicine, Kecioren Training and Research Hospital, Department of Endocrinology and Metabolism, Turkey.46Ege University, School of Medicine, Department of Endocrinology and Metabolism, Turkey.47University of Health Sciences, School of Medicine, Izmir Ataturk Training and Research Hospital, Department of Endocrinology and Metabolism, Turkey.48Dokuz Eylul University, School of Medicine, Department of Endocrinology and Metabolism, Turkey.49Adnan Menderes University, School of Medicine, Department of Endocrinology and Metabolism, Turkey.50Pamukkale University, School of Medicine, Department of Endocrinology and Metabolism, Turkey.51Celal Bayar University, School of Medicine, Department of Endocrinology and Metabolism, Turkey.52Mugla University, School of Medicine, Department of Endocrinology and Metabolism, Turkey.53University of Health Sciences, School of Medicine, Antalya Training and Research Hospital, Department of Endocrinology and Metabolism, Turkey.54Mersin University, School of Medicine, Department of Endocrinology and Metabolism, Turkey.55Kahramanmaras Sutcu Imam University, School of Medicine, Department of Endocrinology and Metabolism, Turkey.56Baskent University, Adana Training Hospital, Department of Endocrinology and Metabolism, Turkey.5719 Mayıs University, School of Medicine, Department of Endocrinology and Metabolism, Turkey.58University of Health Sciences, School of Medicine, Samsun Training and Research Hospital, Department of Endocrinology and Metabolism, Turkey.59Gaziosmanpasa University, School of Medicine, Department of Endocrinology and Metabolism, Turkey.60Hitit University, School of Medicine, Department of Endocrinology and Metabolism, Turkey.61Giresun University, School of Medicine, Department of Endocrinology and Metabolism, Turkey.62Recep Tayyip Erdogan University, School of Medicine, Department of Endocrinology and Metabolism, Turkey.63Karadeniz Technical University, School of Medicine, Department of Endocrinology and Metabolism, Turkey.64Bulent Ecevit University, School of Medicine, Department of Endocrinology and Metabolism, Turkey.65Kars Harakani State Hospital, Department of Endocrinology and Metabolism, Turkey.66Inonu University, School of Medicine, Department of Endocrinology and Metabolism, Turkey.67Erzincan University, School of Medicine, Department of Endocrinology and Metabolism, Turkey.68Yuzuncu Yil University, School of Medicine, Department of Endocrinology and Metabolism, Turkey.69Dicle University, School of Medicine, Department of Endocrinology and Metabolism, Turkey.70University of Health Sciences, School of Medicine, Gaziantep Ersin Arslan Research and Training Hospital, Turkey.71Gaziantep University, School of Medicine, Department of Endocrinology and Metabolism, Turkey.
- Published
- 2020