Skip to main content
SpringerLink
Log in

Achieving lipid goals in type 2 diabetic patients with dyslipidemia: barriers to treatment—the patient perspective

  • Original Article
  • Published:
International Journal of Diabetes in Developing Countries Aims and scope Submit manuscript

Abstract

Objective

Statin treatment compliance and achieving target levels differ between populations. This study aimed to determine the status of achieving the lipid targets and evaluate patients’ compliance to statin treatment in type 2 diabetic patients with dyslipidemia.

Method

This cross-sectional study included type 2 diabetes mellitus (T2DM) patients with dyslipidemia who applied for treatment at our polyclinics. Statin compliance was evaluated using the Modified Morisky Adherence Scale (MMAS-8) through a face-to-face interview. Cardiovascular (CV) risk was calculated according to the 2019 ESC (European Society of Cardiology) criteria by evaluating the patients’ individual risk factors. LDL targets were determined according to risk categories with the same criteria.

Results

A total of 504 patients (F/M: 274/230) were included. The serum LDL levels were 102.6 ± 39.2 mg/dL. Of the patients, 56.1% were under statin treatment. CV risk was very high in 73.6% of patients. LDL levels were significantly lower in users than in non-users (91.2 ± 26.0, 117.3 ± 38.4, p < 0.0001). The rate of reaching the LDL target was 14.8% in statin users. Treatment compliance was low for 40.6% of statin users. Discontinuation of statin treatment due to side effects was 15.7% (n = 14). N = 49 patients willingly discontinued statin treatment. They reported that 40.8% considered the treatment unnecessary.

Conclusion

It was observed that 56.1% of type 2 diabetic patients were on statin therapy. A small percentage of them 14.8% (n = 42) reached the LDL target. Statin non-compliance and a lack of awareness of the statin treatment are the main reasons for high LDL levels in type 2 diabetic patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Data Availability

Data sharing not applicable.

References

  1. Haffner SM. Dyslipidemia management in adults with diabetes. Diabetes Care. 2004;27(Suppl 1):S68-71.

    PubMed  Google Scholar 

  2. Low Wang CC, Hess CN, Hiatt WR, Goldfine AB. Clinical update: cardiovascular disease in diabetes mellitus: atherosclerotic cardiovascular disease and heart failure in type 2 diabetes mellitus - mechanisms, management, and clinical considerations. Circulation. 2016;133(24):2459–502.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Baigent C, Blackwell L, Emberson J, Holland L, Reith C, Bhala N, et al. Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised trials. Lancet (London, England). 2010;376(9753):1670–81.

    Article  CAS  PubMed  Google Scholar 

  4. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). Jama. 2001;285(19):2486–97.

  5. Kotseva K, De Bacquer D, De Backer G, Rydén L, Jennings C, Gyberg V, et al. Lifestyle and risk factor management in people at high risk of cardiovascular disease. A report from the European Society of Cardiology European Action on Secondary and Primary Prevention by Intervention to Reduce Events (EUROASPIRE) IV cross-sectional survey in 14 European regions. Eur J Prev Cardiol. 2016;23(18):2007–18.

    Article  PubMed  Google Scholar 

  6. Kültürsay H. Results of the rosuvastatin studies in Turkey. Arch Turk Soc Cardiol. 2007;35(Supp: 1):24–30.

    Google Scholar 

  7. Mann DM, Woodward M, Muntner P, Falzon L, Kronish I. Predictors of nonadherence to statins: a systematic review and meta-analysis. Ann Pharmacother. 2010;44(9):1410–21.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Benner JS, Glynn RJ, Mogun H, Neumann PJ, Weinstein MC, Avorn J. Long-term persistence in use of statin therapy in elderly patients. JAMA. 2002;288(4):455–61.

    Article  PubMed  Google Scholar 

  9. Jackevicius CA, Mamdani M, Tu JV. Adherence with statin therapy in elderly patients with and without acute coronary syndromes. JAMA. 2002;288(4):462–7.

    Article  PubMed  Google Scholar 

  10. Cosentino F, Grant PJ, Aboyans V, Bailey CJ, Ceriello A, Delgado V, et al. ESC Scientific Document Group. 2019 ESC guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Eur Heart J. 2020;41(2):255–323.

    Article  PubMed  Google Scholar 

  11. Morisky DE, Ang A, Krousel-Wood M, Ward HJ. Predictive validity of a medication adherence measure in an outpatient setting. J Clin Hypertens (Greenwich). 2008;10(5):348–54.

    Article  PubMed  Google Scholar 

  12. Sayiner ZA. Diabetes mellitusta morisky tedavi uyum ölçeği-8’ in Türkçe geçerlilik güvenilirlik çalişmasi ve hastalarda tedavi uyumunu gösteren faktörlerle ilişkisinin saptanmasi, uzmanlik tezi, Ankara, 2014.

  13. Oğuzülgen İK, Köktürk N, Işıkdoğan Z. Astım ve Kronik obstrüktif akciğer hastalarında Morsiky 8-Maddeli uyum anketinin (MMAS-8) Türkçe geçerliliğinin kanıtlanması çalışması. Tuberk Toraks. 2014;62:101–7.

    Article  PubMed  Google Scholar 

  14. Vezzani S, Giannetta E, Altieri B, Barbonetti A, Bellastella G, Certo R, et al. An Italian survey of compliance with major guidelines for l-thyroxine of primary hypothyroidism. Endocr Pract. 2018;24(5):419–28.

    Article  PubMed  Google Scholar 

  15. De Cosmo S, Viazzi F, Pacilli A, Giorda C, Ceriello A, Gentile S, et al. Achievement of therapeutic targets in patients with diabetes and chronic kidney disease: insights from the Associazione Medici Diabetologi Annals initiative. Nephrol Dial Transplant. 2015;30(9):1526–33.

    Article  PubMed  Google Scholar 

  16. Heintjes E, Kuiper J, Lucius B, Penning-van Beest F, Kutikova L, Liem A, et al. Characterization and cholesterol management in patients with cardiovascular events and/or type 2 diabetes in the Netherlands. Curr Med Res Opin. 2017;33(1):91–100.

    Article  CAS  PubMed  Google Scholar 

  17. Kotseva K, De Bacquer D, De Backer G, Rydén L, Jennings C, Gyberg V, et al. Lifestyle and risk factor management in people at high risk of cardiovascular disease. A report from the European Society of Cardiology European Action on Secondary and Primary Prevention by Intervention to Reduce Events (EUROASPIRE) IV cross-sectional survey in 14 European regions. Eur J Prev Cardiol. 2016;23(18):2007–18.

    Article  PubMed  Google Scholar 

  18. Kültürsay H. Results of the rosuvastatin studies in Turkey. Arch Turk Soc Cardiol. 2007;35(Supp: 1):24–30.

    Google Scholar 

  19. Mert G, Başaran Ö, Mert KU, Doğan V, Özlek B, Çelik O, et al. The reasons of poor lipid target attainment for secondary prevention in real life practice: results from EPHESUS. Int J Clin Pract. 2019;73(9):1–9.

    Article  CAS  PubMed  Google Scholar 

  20. Ergin E, Akın S, Kazan S, Erdem M, Tekçe M, Aliustaoğlu M. Lipid profile of diabetic patients: awareness and the rate of treatment success. SCIE. 2013;24(3):157–63.

    Google Scholar 

  21. Yiğiner Ö, Özmen N, Özçelik F, İnanç T, Kardeşoğlu E, Uz Ö, et al. Adherence to statin therapy and LDL cholesterol goal attainment in type 2 diabetics and secondary prevention patients: the role of education and knowledge. Turk Kardiyol Dern Ars. 2010;38(8):544–50.

    PubMed  Google Scholar 

  22. Tokgözoğlu L, Özdemir R, Altındağ R, Ceyhan C, Yeter E, Öztürk C, et al. Patient characteristics and statin discontinuation-related factors during treatment of hypercholesterolemia: an observational non-interventional study in patients with statin discontinuation (STAY study). Turk Kardiyol Dern Ars. 2016;44(1):53–64.

    PubMed  Google Scholar 

  23. Stroes ES, Thompson PD, Corsini A, Vladutiu GD, Raal FJ, Ray KK, et al. Statin-associated muscle symptoms: impact on statin therapy-European Atherosclerosis Society consensus panel statement on assessment, aetiology and management. Eur Heart J. 2015;36(17):1012–22.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Kocas C, Abaci O, Kocas BB, Cetinkal G, Arslan S, Yildiz A, et al. The role of media on statin adherence. Int J Cardiol. 2015;201:139.

    Article  PubMed  Google Scholar 

  25. Pokharel Y, Akeroyd JM, Ramsey DJ, Hira RS, Nambi V, Shah T, et al. Statin use and its facility-level variation in patients with diabetes: insight from the Veterans Affairs National Database. Clin Cardiol. 2016;39(4):185–91.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Gant CM, Binnenmars SH, Harmelink M, Soedamah-Muthu SS, Bakker SJL, Navis G, et al. Real-life achievement of lipid-lowering treatment targets in the DIAbetes and LifEstyle Cohort Twente: systemic assessment of pharmacological and nutritional factors. Nutr Diabetes. 2018;8(1):24.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Özkan Y, Çolak R, Koca SS, Dağ S, Kan EK, Sırma N. Diyabet ve hiperlipidemi: Tedavide ne kadar başarılıyız. FÜ Sağ Bil Derg. 2008;22(2):97–100.

    Google Scholar 

Download references

Acknowledgments

We express our gratitude to the colleagues, who supported our research, at the internal medicine, endocrinology and cardiology departments of our hospital.

Author information

Authors and Affiliations

  1. Department of Internal Medicine, Sancaktepe Sehit Prof. Dr. Ilhan Varank Training and Research Hospital, University of Health Sciences, Istanbul, Turkey

    Naime Afşar Satış

  2. Department of Endocrinology and Metabolism, Marmara University School of Medicine, Istanbul, Turkey

    Dilek Gogas Yavuz

Authors
  1. Naime Afşar Satış
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dilek Gogas Yavuz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Naime Afşar Satış.

Ethics declarations

Ethics approval and consent to participate

The clinical study was approved by the Ethics Committee of Marmara University Faculty of Medicine (Approval Date: 12.06.2020, Approval Number: 09.2020.626). The research protocol was implemented according to the principles expressed in the World Medical Association Declaration of Helsinki and under the International Ethical Guidelines for Biomedical Research Involving Subjects (GIOMS, Geneva, 1993). Informed consent was obtained from all subjects.

Competing interests

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Highlights

• In diabetic patients, the LDL targets specified by the guidelines cannot be achieved.

• In diabetic patients, compliance with statin therapy is low.

• Diabetic patients consider statin therapy unnecessary.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Afşar Satış, N., Gogas Yavuz, D. Achieving lipid goals in type 2 diabetic patients with dyslipidemia: barriers to treatment—the patient perspective. Int J Diabetes Dev Ctries (2023). https://doi.org/10.1007/s13410-023-01238-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s13410-023-01238-9

Keywords

Search

Navigation