In the Journals

CVD risk may influence medication use in type 2 diabetes

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October 6, 2015

More than half of patients with diabetes in the United Kingdom are already prescribed cardioprotective drugs at diagnosis, rising to more than 80% after 5 years, according to recent study findings published in BMJ Open Diabetes Research & Care.

“Despite the increasing number of individuals with screen-detected diabetes, many of whom have comorbidities, there is an absence of knowledge about what the pharmacotherapy burden is at diagnosis in this population, and how it changes in the first 5 years,” the researchers wrote. “It is important that this is described so that patients and practitioners are informed about the likely course and burden of treatment.”

Simon J. Griffin, DM, of the MRC Epidemiology Unit at the University of Cambridge, and colleagues evaluated prescription history data from the ADDITION-UK trial on 1,026 adults (mean age, 61 years) with screen-detected diabetes to determine the pharmacotherapy burden of these patients at diagnosis and 1 and 5 years after diagnosis.

Most participants reported taking two medications at diagnosis, most commonly a cardioprotective medication. At 1 year after diagnosis, there was a median of three medications, and at 5 years, participants were on six medications.

Diabetes medications were prescribed for 23% of patients at 1 year and for 62% of patients by 5 years. Similarly, the prescriptions for antihypertensive, lipid-lowering and antithrombotic medications increased between diagnosis and 1 and 5 years. Seventy-eight percent of participants reported not using glucose-lowering medications at 1 year, and 38% reported no use at 5 years.

Other types of medications were prescribed to 42% of participants at diagnosis, increasing to 62% 5 years after diagnosis. The most common prescription was for gastrointestinal conditions (13% of patients at diagnosis; 25% at 5 years), followed by anti-inflammatory (12% at diagnosis; 12% at 5 years), analgesic (12% at diagnosis; 19% at 5 years) and psychotherapy (11% at diagnosis; 15% at 5 years) drugs.

The researchers also found that a higher baseline United Kingdom Prospective Diabetes Study (UKPDS) cardiovascular disease risk score was associated with an increase in the number of prescribed drugs from diagnosis to 5 years after diagnosis and of prescriptions for cardioprotective and diabetes-related medications.

“The increased prescription of cardioprotective medication was associated with higher baseline CVD risk, indicating an association between need and care,” the researchers wrote. “While this result is promising, it remains unclear if the prescription rates of glycemic and cardioprotective medication in this population with elevated CV risk reflect individualized treatment based on patient-led priorities or a deficit in the application of pharmacological intervention.” – by Amber Cox

Disclosure: Griffin reports nonfinancial support from Eli Lilly and personal fees from Eli Lilly. Please see the full study for a list of all other authors’ relevant financial disclosures.