Abstract Body (Do not enter title and authors here): Background: In patients with diabetes mellitus (DM), lipid-lowering therapy (LLT) with statins +/- adjuvant LLT are recognised treatment approaches. It is unknown what proportion of patients with DM are prescribed LLT, have documented low-density lipoprotein cholesterol (LDL-C) levels, or achieve guideline LDL-C targets.
Aims: To document population trends in (i) the incidence and prevalence of DM, (ii) prescribing of LLT, and (iii) testing and achievement of LDL-C targets in patients with or without atherosclerotic cardiovascular disease (ASCVD).
Methods: We conducted a retrospective, population-level, observational study using linked anonymised health record data amongst 269,735 diabetic patients in Wales (UK). Associations between patient characteristics and (i) statin prescription and (ii) achievement of LDL-C target of (<1.8 mmol/L) were evaluated.
Results: The prevalence of DM increased from 6,519 to 8,128 per 100k, and incidence increased from 543 to 633 per 100k per year (2010-21). The proportion of patients prescribed any LLT decreased from 89.5% to 82.9% in those with ASCVD and from 53.2% to 37.8% without. An increasing and greater proportion of patients with ASCVD were prescribed high-intensity statin therapy (14.1% to 36.1%) over the study period, compared to those without (2.3% to 5.1%; Figure 1).
The proportion of patients with documented LDL-C decreased (from 68.1% to 52.3% in those with ASCVD and 64.7% to 48.3% without) over the study period. A greater proportion of those with ASCVD achieved an LDL-C <1.8 mmol/L (43.1% to 45.4%) than those without (22.2% to 22.0%). In a multivariate logistic regression, presence of ASCVD and history of hypertension were associated with prescription of statin therapy (ORs = 4.01, 1.75, respectively; both p < 0.01). Male sex and presence of ASCVD were associated with achievement of LDL-C target (ORs = 1.25, 8.15; both p < 0.01).
Conclusions: The incidence and prevalence of DM is increasing over time, but the overall quality of lipid management is decreasing, as evidenced by documented testing, treatment and control of LDL-C. In order to realise the full evidence-based benefit from LLT, improvement in the implementation of guideline-recommended care is required.