Endocrine Abstracts

Introduction: The major cause of death and disability in patients with diabetes mellitus is atherosclerotic cardiovascular disease (ASCVD). Therefore, treatment guidelines specify strict target lipid levels for these patients. The aim of this study is to evaluate the adherence of diabetes mellitus type 1 and 2 patients (DM1 and DM2, respectively) with respect to the European and Swiss lipid treatment guidelines (ESC/EAS and AGLA, respectively).

Methods: The Swiss Diabetes Registry (SwissDiab) is a multicenter prospective observational cohort study of patients with diabetes treated at Swiss tertiary centers. Participants with DM1 and DM2 and a visit between 01.01.2018 and 30.09.2019 were included. Achievement of the LDL-cholesterol targets defined by the 2016 ESC/EAS and 2018 AGLA guidelines was assessed. Baseline characteristics as well as lipid-lowering medication were assessed stratified by diabetes type and in secondary analysis also by adherence to the respective guidelines.

Results: Overall, 187 participants with DM1 and 260 with DM2 were included. The ESC/EAS and AGLA LDL-cholesterol targets were met in 38% of DM1 participants and in 36% of DM2 participants. Among participants that did not reach the LDL-cholesterol targets based on the ESC and AGLA guidelines, 69% with DM1 and 26% with DM2 were not prescribed lipid-lowering medication. No difference in baseline characteristics, diabetes duration and HbA1c was observed between participants that reached and did not reached the LDL-cholesterol targets, regardless of diabetes type.

Conclusion: The proportion of SwissDiab participants with DM1 and DM2 that reach the LDL-cholesterol treatment targets is poor (< 40%), consistent with previous studies showing that 20–40% of patients at high risk of ASCVD, such as DM patients, fail to reach established lipid treatment targets. The majority of DM1 patients that do not reach the LDL-cholesterol targets are not prescribed any lipid-lowering medication, suggesting that initiation of any lipid-lowering treatment would improve adherence to the lipid guidelines. The majority of DM2 patients do not reach the LDL-cholesterol targets despite being prescribed lipid-lowering medication, suggesting that combination lipid-lowering therapy should be reinforced to improve adherence to the lipid guidelines. In summary, our data strongly support that lipid-lowering strategies including high-dose statins and combination lipid-lowering treatments must be reinforced in Swiss patients with diabetes. The need is even more pressing in light of the more stringent 2019 ESC/EAS lipid guidelines in order to follow current recommendations and provide patients with the full benefits of these therapies.