title: Underutilization of statins in patients with type 2 diabetes in US clinical practice: a retrospective cohort study.
abstract: OBJECTIVE
  To estimate the proportion of patients with type 2 diabetes who were eligible for statin treatment per American Diabetes Association (ADA) recommendations and the proportion who were actually prescribed a statin in US clinical practice. Factors associated with receiving a statin prescription were also determined.
  
  
  METHODS
  Patients ≥ 25 years diagnosed with type 2 diabetes or had received prescriptions for antihyperglycemic agents between 7/2006 and 6/2008 were identified within a large electronic medical record database. Eligibility for statin therapy was determined according to 2008 ADA recommendations. Statin use was assessed based on prescription records during a 12-month follow-up period. An adjusted logistic regression analysis was performed to estimate the likelihood of statin use in relation to selected baseline characteristics.
  
  
  RESULTS
  Of the 125,464 patients identified, 98.5% were eligible for statin therapy. Only 62.9% received a statin prescription during follow-up period. In an adjusted logistic regression, factors associated with increased likelihood of statin use were older age, male gender, smoking, history of cardiovascular conditions, and receiving an antihyperglycemic, antihypertensive, or anticoagulant prescription at baseline (all p < 0.05).
  
  
  CONCLUSIONS
  Of the patients who did not receive statin during follow-up, 13% of them were previously on a statin during the baseline period. The reasons for discontinuing therapy are not known. It cannot be excluded that some of these patients were intolerant or had contraindications to statin. The data on prescription dispensing and compliance were not recorded.
  
  
  CONCLUSIONS
  Nearly all patients with type 2 diabetes were eligible for statin therapy, but less than two-thirds received statin therapy in US clinical practice. Efforts to minimize this gap are warranted.
authors.affiliation: Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH 44195, USA. fuz@ccf.org
authors.forename: Alex Z
authors.initials: AZ
authors.lastname: Fu
authors.forename: Qiaoyi
authors.initials: Q
authors.lastname: Zhang
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Davies
authors.forename: Sri-Ram
authors.initials: SR
authors.lastname: Pentakota
authors.forename: Larry
authors.initials: L
authors.lastname: Radican
authors.forename: Thomas
authors.initials: T
authors.lastname: Seck
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D016208:Databases, Factual; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors