Background: Guidelines recommend optimal control of cardiovascular risk factors such as blood pressure, lipids and smoking in addition to glycemic control to reduce the risk of micro and macro-vascular complications in patients with type 2 diabetes mellitus (T2D). However, the extent of comprehensive cardiovascular risk factor control in T2D internationally is not well-known.
Methods: A total of 14,169 T2D patients initiating second-line therapy across 37 countries were enrolled in the DISCOVER registry. Optimal cardiovascular risk factor management at study baseline was defined as control of the following risk factors among eligible patients: 1) Systolic BP <140mmHg for all T2D patients; 2) statin prescription in all T2D patients ≥ 40 years, high-intensity statin for those with T2D and ASCVD; 3) non-smoking status for all T2D patients; 4) treatment with ACE-Inhibitor/Angiotensin Receptor Blocker (ACEI/ARB) in patients with T2D and 5) hypertension (HTN)/albuminuria and secondary ASCVD prevention with low-dose aspirin (ASA) in those with T2D and ASCVD. Global and country specific rates of individual and combined risk factor control were calculated. Inter-country variability was estimated using median odds ratios (MOR).
Results: Mean age of the DISCOVER cohort was 56.6 (SD= 11.7) years; 7534 (53.2%) were male, mean BMI was 29.6 (SD= 5.9) kg/m2, median duration of T2D was 4.1 (IQR 2.0, 7.8) years. A total of 1643 (11.9%) patients had ASCVD, 7221 (51.0%) had HTN and 606 (4.3%) had albuminuria. Overall, among eligible patients, BP was controlled in 67.2% (9043/13457); statin treatment was prescribed in 38.3% (4977/12987); 85.2% (12,075/14169) were not smoking; ACEI/ARB treatment was prescribed in 53.7% (4917/9151), and ASA for secondary prevention was prescribed in 51.6% (847/1643) patients with ASCVD. Of 13,118 patients with 3 or more risk factors, 5312 (40.5%) had optimal control of at least 3 risk factors with wide inter-country variability.
Conclusion: In a global registry of individuals with T2D from 37 countries, comprehensive control of ASCVD risk factors was not achieved in most patients, with wide variability among countries. Better strategies are needed to consistently provide comprehensive cardiovascular risk factor control in patients with T2D to improve long term outcomes.