Background Cardiovascular disease (CVD) is the primary cause of morbidity and mortality in type 2 diabetes and constitutes the largest component of healthcare expenditure in the management of type 2 diabetes. However, our understanding of cardiovascular drug utilisation patterns in newly treated type 2 diabetes is limited, having primarily focused on subjects aged 65 years and older. Therefore, the aims of this study were to: 1) characterise in terms of treatment initiation, the CVD agent utilisation patterns in a cohort of newly treated type 2 diabetes patients aged 40 years and over who were previously treatment naive to CVD agents and 2) to investigate the association of age, gender, and initial antidiabetic agent with CVD utilisation after treatment for type 2 diabetes in this cohort.
Methods A population-based retrospective cohort study was conducted using the national pharmacy claims database in Ireland. Subjects were analysed for use of aspirin, antihypertensives, and lipid lowering drugs one year after antidiabetic agent initiation. Logistic regression was used to examine associations of socio-demographic and treatment factors on CVD agent use. Odds ratios (OR) and 95% CIs are presented.
Results A total of 6093 subjects were identified in the study over a 2 year period (2008, 2009) with 69% of subjects receiving a lipid lowering drug, 58% of subjects receiving an angiotensin-converting-enzyme inhibitor/angiotensin receptor blocker, and 58% of subjects receiving aspirin. Subjects aged 40–49 years were significantly less likely than those aged 60–69 years to receive aspirin (OR 0.66, CI 0.57–0.77), antihypertensives (OR 0.41, CI 0.35–0.48) and lipid lowering drugs (OR 0.75, CI 0.64–0.88). While subjects initiated on a sulphonylurea were significantly less likely to receive aspirin (OR 0.83, CI 0.73–0.93), or lipid lowering drugs (OR 0.84, CI 0.74–0.95). Subjects aged 40–49 were significantly less likely to receive aspirin in combination with lipid lowering drugs than those aged 60–69 years (OR 0.72 CI 0.59, 0.88).
Conclusion Substantial use of CVD agent one year after treatment initiation was observed. Younger subjects were less likely to receive CVD agents as well as certain guideline recommended therapies, however, lifestyle modifications might have been preferred in these age groups. It is possible that use of CVD agents might be further optimised, but in the absence of additional clinical information and prescribers’ insight, stronger conclusions cannot be drawn from the data. Future work should seek to address this issue.
- type 2 diabetes
- Treatment Patterns
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