Global patterns of comprehensive cardiovascular risk factor control in patients with type 2 diabetes mellitus: Insights from the DISCOVER study. Issue 1 (22nd September 2020) - Patel, Krishna K.
Abstract: Aim: To investigate global patterns of cardiovascular risk factor control in patients with type 2 diabetes mellitus (T2D). Methods: DISCOVER is an international, observational cohort study of patients with T2D beginning second‐line glucose‐lowering therapy. Risk factor management was examined among eligible patients (ie, those with the risk factor) at study baseline. Inter‐country variability was estimated using median odds ratios (MORs). Results: Among 14 343 patients with T2D from 34 countries, the mean age was 57.4 ± 12.0 years and the median (interquartile range) duration of T2D was 4.2 (2.0–8.0) years; 11.8% had documented atherosclerotic cardiovascular disease (ASCVD). Among eligible patients, blood pressure was controlled in 67.5% (9284/13756), statins were prescribed in 43.7% (5775/13208), angiotensin‐converting enzyme inhibitors/angiotensin II receptor blockers were prescribed in 55.6% (5292/9512), aspirin was prescribed in 53.3% of those with established ASCVD (876/1645), and 84.4% (12 102/14343) were non‐smoking. Only 21.5% of patients (3088/14343) had optimal risk factor management (defined as control of all eligible measures), with wide inter‐country variability (10%–44%), even after adjusting for patient and site differences (MOR 1.47, 95% confidence interval 1.24–1.66). Conclusion: Globally, comprehensive control of ASCVD risk factors is not being achieved in most patients, with wide variability among countries unaccounted for by patient and site differences. Better country‐specific strategies are needed to implement comprehensive cardiovascular risk factor control consistently in patients with T2D to improve long‐term outcomes.