Cardiovascular (CV) diseases remain a leading cause of morbidity and mortality in people with Type 2 Diabetes Melitus (T2DM). Good glycemic management is not sufficient to decrease markedly CV risk and new evidences show that the choice of the glucose-lowering medications (GLM) is a key component to decrease this risk. New ESC guidelines recommend the use of GLM with proven CV benefits for patients at high or very high CV risk.
To evaluate the compliance of T2DM treatment at patient admission with the ESC Guidelines for patients hospitalized in cardiology units.
We retrospectively reviewed the usual treatments of patients with T2DM hospitalized in cardiology units between January and March 2020. Usual GLM were extracted from medication reconciliations which are carried out routinely by the pharmaceutical team present in the 3 cardiology units. CV history and haemoglobin A1c (HbA1c) value were collected from medical records.
Data from 179 patients were collected. The mean age was 72 years and the sex ratio was 3.5. 88% of the patients had a very high CV risk and 12% a high risk. The most prescribed drugs were metformin (115), long-acting insulins (65), rapid-acting insulins (65), DPP-4i (48), sulfonylureas (41) and GLP1-RA (21). 35% of patients had a recommended treatment. The 3 most frequently non-recommended combination therapies are insulin dual therapy (12%), sulfonylureas monotherapy (9%), and metformin with insulin dual therapy (8%). Among patients with recommended treatment, 95% had a controlled HbA1c (<8%), compared with only 58% for patients with unrecommended treatment.
Most of patients were at very high risk of CV complications. Moreover, only 12% of patients had one of the first-line treatment for this category of patients (GLP1-RA). The recommended combinations of treatment were prescribed only in approximatively one third of patients. This work demonstrates that improvements are necessary in the management of patients with D2TM at high CV risk.Le texte complet de cet article est disponible en PDF.