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A large remaining potential in lipid-lowering drug treatment in the type 2 diabetes population: A Danish nationwide cohort study

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Aim: To assess lipid-lowering drug (LLD) use patterns during 1996-2017 and examine lipid levels in relation to the use of LLDs and prevalent atherosclerotic cardiovascular disease (ASCVD). Methods: Using a nationwide diabetes register, 404 389 individuals with type 2 diabetes living in Denmark during 1996-2017 were identified. Individuals were followed from 1 January 1996 or date of type 2 diabetes diagnosis until date of emigration, death or 1 January 2017. Redemptions of prescribed LLDs were ascertained from the nationwide Register of Medicinal Products Statistics. Data on lipid levels were sourced from the National Laboratory Database since 2010. LLD coverage was calculated at any given time based on the redeemed amount and dose. Trends in lipid levels were estimated using an additive mixed-effect model. Low-density lipoprotein cholesterol (LDL-C) goal attainment was assessed based on recommended targets by the 2011, 2016 and 2019 guidelines for management of dyslipidaemias. Results: LLD use has decreased since 2012 and only 55% of those with type 2 diabetes were LLD users in 2017. A decline in levels of total cholesterol and LDL-C, and an increase in triglycerides, was observed during 2010-2017. Annual mean levels of LDL-C were lower among LLD users compared with non-users (in 2017: 1.84 vs. 2.57 mmol/L). A greater fraction of LLD users achieved the LDL-C goal of less than 1.8 mmol/L compared with non-users (in 2017: 51.7% and 19%, respectively). Among LLD users with prevalent ASCVD, 26.9% and 55% had, as recommended by current 2019 European guidelines, an LDL-C level of less than 1.4 mmol/L and less than 1.8 mmol/L, respectively, in 2017. Conclusions: LLD use and LDL-C levels are far from optimal in the Danish type 2 diabetes population and improvement in LLD use could reduce ASCVD events.

TidsskriftDiabetes, Obesity and Metabolism
Udgave nummer10
Sider (fra-til)2354-2363
Antal sider10
StatusUdgivet - okt. 2021

Bibliografisk note

Funding Information:
We thank Lars J. Diaz for his contribution and guidance related to the statistical modelling. We are grateful to the Danish Clinical Registries (RKKP) for providing access to the Danish Adult Diabetes Database and Database for Screening of Diabetic Retinopathy and Maculopathy that was used for the construction of the diabetes register. We appreciate the meticulous and speedy support of the Research Service of Statistics Denmark and the Danish Health Data Agency. This work was supported by Amgen.

Funding Information:
MEJ, BC, HA and PFR own shares in Novo Nordisk A/S. MEJ has received research grants from AstraZeneca, Sanofi Aventis, AMGEN and Boehringer Ingelheim. FP reports having received research grants from AstraZeneca, Novo Nordisk and Novartis, and lecture fees from Novartis, Eli Lilly, MSD, AstraZeneca, Sanofi, Novo Nordisk and Boehringer Ingelheim, and having served as a consultant for AstraZeneca, Bayer, Amgen, Novo Nordisk and MSD. No other potential conflicts of interest relevant to this article were reported for the remaining authors.

Publisher Copyright:
© 2021 John Wiley & Sons Ltd.

Copyright 2021 Elsevier B.V., All rights reserved.

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