Changes in the Prescription of Glucose‐Lowering Medications in Patients With Type 2 Diabetes Mellitus After a Cardiovascular Event: A Call to Action From the DATAFILE Study
Background Evidence accumulated that some glucose‐lowering medications protect against cardiovascular events (CVEs) in patients with type 2 diabetes mellitus (T2DM) and established cardiovascular disease. The present study evaluated if and how glucose‐lowering medication prescription pattern changes...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2019-07-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.119.012244 |
| _version_ | 1811332310205726720 |
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| author | Gian Paolo Fadini Vera Frison Natalino Simioni Annunziata Lapolla Adriano Gatti Antonio Carlo Bossi Andrea Del Buono Paolo Fornengo Lucia Gottardo Mario Laudato Gianluca Perseghin Enzo Bonora Angelo Avogaro |
| author_facet | Gian Paolo Fadini Vera Frison Natalino Simioni Annunziata Lapolla Adriano Gatti Antonio Carlo Bossi Andrea Del Buono Paolo Fornengo Lucia Gottardo Mario Laudato Gianluca Perseghin Enzo Bonora Angelo Avogaro |
| author_sort | Gian Paolo Fadini |
| collection | DOAJ |
| description | Background Evidence accumulated that some glucose‐lowering medications protect against cardiovascular events (CVEs) in patients with type 2 diabetes mellitus (T2DM) and established cardiovascular disease. The present study evaluated if and how glucose‐lowering medication prescription pattern changes in T2DM after a CVE. Methods and Results DATAFILE (Diabetes Therapy After a Cardiovascular Event) was a retrospective multicenter study conducted at 12 diabetes mellitus specialist outpatient clinics in Italy. We identified T2DM patients with an incident CVE for whom a follow‐up visit was available after the event. We selected control T2DM patients without an incident CVE, who were matched with cases for age, sex, known diabetes mellitus duration, baseline hemoglobin A1c, kidney function, and follow‐up time. We extracted clinical variables and compared prescribed therapies at baseline and follow‐up. We included 563 patients with and 497 matched patients without an incident CVE. As expected, patients with a subsequent CVE had a higher baseline prevalence of ischemic heart disease. After a median of 9.5 months, in patients with versus those without a CVE, there was a significant increase in the prescription of beta‐blockers, loop diuretics, dual antiplatelet therapy, and, among glucose‐lowering medications, a significant decrease in metformin. Hemoglobin A1c marginally declined only in the control group, whereas low‐density lipoprotein cholesterol decreased only in patients with CVE. Conclusions This study highlights that occurrence of a CVE in T2DM patients did not prime the prescription of glucose‐lowering medications provided with cardiovascular protective effects, even though glucose control remained poor. These data emphasize the need to optimize the therapeutic regimen of T2DM patients with established cardiovascular disease, according to updated guidelines. |
| first_indexed | 2024-04-13T16:34:01Z |
| format | Article |
| id | doaj.art-59e2c8b2a3aa46b5b9f78c3ddf8c5d8d |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-13T16:34:01Z |
| publishDate | 2019-07-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-59e2c8b2a3aa46b5b9f78c3ddf8c5d8d2022-12-22T02:39:28ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802019-07-0181410.1161/JAHA.119.012244Changes in the Prescription of Glucose‐Lowering Medications in Patients With Type 2 Diabetes Mellitus After a Cardiovascular Event: A Call to Action From the DATAFILE StudyGian Paolo Fadini0Vera Frison1Natalino Simioni2Annunziata Lapolla3Adriano Gatti4Antonio Carlo Bossi5Andrea Del Buono6Paolo Fornengo7Lucia Gottardo8Mario Laudato9Gianluca Perseghin10Enzo Bonora11Angelo Avogaro12Department of Medicine University of Padova ItalyDiabetology Service ULSS6 Cittadella ItalyDiabetology Service ULSS6 Cittadella ItalyDiabetology Service ULSS6 Padova ItalyDiabetology Service ASL Napoli 1 Centro Napoli ItalyASST Bergamo Ovest Treviglio ItalyDiabetology Service Cellole (CE) ItalyDepartment of Medicine Internal Medicine 3 University Hospital of Turin ItalyInternal Medicine and Diabetology ULSS3 Venice ItalyDiabetology Service Caserta ItalyDepartment of Medicine and Rehabilitation Policlinico di Monza and University of Milan Bicocca Monza ItalyDivision of Endocrinology, Diabetes and Metabolism University and Hospital Trust of Verona Verona ItalyDepartment of Medicine University of Padova ItalyBackground Evidence accumulated that some glucose‐lowering medications protect against cardiovascular events (CVEs) in patients with type 2 diabetes mellitus (T2DM) and established cardiovascular disease. The present study evaluated if and how glucose‐lowering medication prescription pattern changes in T2DM after a CVE. Methods and Results DATAFILE (Diabetes Therapy After a Cardiovascular Event) was a retrospective multicenter study conducted at 12 diabetes mellitus specialist outpatient clinics in Italy. We identified T2DM patients with an incident CVE for whom a follow‐up visit was available after the event. We selected control T2DM patients without an incident CVE, who were matched with cases for age, sex, known diabetes mellitus duration, baseline hemoglobin A1c, kidney function, and follow‐up time. We extracted clinical variables and compared prescribed therapies at baseline and follow‐up. We included 563 patients with and 497 matched patients without an incident CVE. As expected, patients with a subsequent CVE had a higher baseline prevalence of ischemic heart disease. After a median of 9.5 months, in patients with versus those without a CVE, there was a significant increase in the prescription of beta‐blockers, loop diuretics, dual antiplatelet therapy, and, among glucose‐lowering medications, a significant decrease in metformin. Hemoglobin A1c marginally declined only in the control group, whereas low‐density lipoprotein cholesterol decreased only in patients with CVE. Conclusions This study highlights that occurrence of a CVE in T2DM patients did not prime the prescription of glucose‐lowering medications provided with cardiovascular protective effects, even though glucose control remained poor. These data emphasize the need to optimize the therapeutic regimen of T2DM patients with established cardiovascular disease, according to updated guidelines.https://www.ahajournals.org/doi/10.1161/JAHA.119.012244appropriatenessdiabetes mellituspharmacology |
| spellingShingle | Gian Paolo Fadini Vera Frison Natalino Simioni Annunziata Lapolla Adriano Gatti Antonio Carlo Bossi Andrea Del Buono Paolo Fornengo Lucia Gottardo Mario Laudato Gianluca Perseghin Enzo Bonora Angelo Avogaro Changes in the Prescription of Glucose‐Lowering Medications in Patients With Type 2 Diabetes Mellitus After a Cardiovascular Event: A Call to Action From the DATAFILE Study Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease appropriateness diabetes mellitus pharmacology |
| title | Changes in the Prescription of Glucose‐Lowering Medications in Patients With Type 2 Diabetes Mellitus After a Cardiovascular Event: A Call to Action From the DATAFILE Study |
| title_full | Changes in the Prescription of Glucose‐Lowering Medications in Patients With Type 2 Diabetes Mellitus After a Cardiovascular Event: A Call to Action From the DATAFILE Study |
| title_fullStr | Changes in the Prescription of Glucose‐Lowering Medications in Patients With Type 2 Diabetes Mellitus After a Cardiovascular Event: A Call to Action From the DATAFILE Study |
| title_full_unstemmed | Changes in the Prescription of Glucose‐Lowering Medications in Patients With Type 2 Diabetes Mellitus After a Cardiovascular Event: A Call to Action From the DATAFILE Study |
| title_short | Changes in the Prescription of Glucose‐Lowering Medications in Patients With Type 2 Diabetes Mellitus After a Cardiovascular Event: A Call to Action From the DATAFILE Study |
| title_sort | changes in the prescription of glucose lowering medications in patients with type 2 diabetes mellitus after a cardiovascular event a call to action from the datafile study |
| topic | appropriateness diabetes mellitus pharmacology |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.119.012244 |
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