Endocrine Abstracts

Introduction: Dyslipidemia (DL) in diabetic patients is frequently undertreated. Even when cLDL targets have not been met, treatment remains unchanged despite the availability of alternatives approaches. This is known as therapeutic inertia (TI).The aim of this study was to evaluate the prevalence of TI in lipid management among diabetic patients and to analyse associated factors and possible causes.

Material and Methods: Retrospective, cross-sectional study. Diabetic patients in secondary prevention followed up in an Endocrinology outpatient clinic, from January to June 2019. All with suboptimal cLDL levels: >70 mg/dl, according to ESC/EAS 2016 guidelines for the management of dyslipidemias. TI was considered when a lipid–lowering agent was not changed or added. Results in mean (Standard Deviation). Bivariate analysis: Pearson chi*square/Student t test.

Results: 78 patients. 61.5% men. Age 72.2 (10) years, duration of diabetes: 16.3 (10.5) years. 94.9% DM 2. Weight 76.2 (14) kg, BMI 28.2 (4.7) kg/m². Mean HbA1c 8 (1.5)%, cLDL 98.5 (25.5) mg/dl, glomerular filtration rate 69.2 (24.7) ml/min. Number of chronic treatments: 10.7 (4). Complications and comorbidities: 56.4% ischemic cardiopathy (IC), 29.5% stroke, 28.6% peripheral artery disease (PAD), 23.6% diabetic nefropathy, 20.8% diabetic retinopathy (DR) and 11.5% diabetic neuropathy (DN). 29.5% with renal insufficiency and 9% with hepatopathy. Cognitive impairment in 6.4%.Type of statin: high potency in 38.8%, low-intermediate potency in 62.2%.14% without any statin. Only 10.7% received the maximum dose of statin. In 5.3% statin intolerance was reported.

cLDL levels were higher in women, hepatopathy, patients taking less than 5 chronic treatments and without statin(P < 0.05).There were no differences depending on age, renal insufficiency, cognitive impairment, HbA1c, statin intolerance, maximum dose of statin and the presence of hypertension, IC and PAD.

TI was observed in 80.7% of patients. It was not modified based on age, duration of diabetes, renal insufficiency, hepatopathy, cognitive impairment, number of chronic treatments nor number of changes in regular treatments. There were also no differences depending on other cardiovascular risk factors and type of vascular disease: tobacco, hypertension, IC, stroke, DN, PAD nor DR.

We observed less TI associated with higher cLDL and lower HbA1c levels (P < 0.05).

Conclusions: TI was common in the lipid management of diabetic patients. We found higher cLDL and lower HbA1c levels as factors that influenced in TI, this could be due to a sequential treatment, optimizing the treatment of DL after an adequate glycemic control. The better management should be an integrated treatment of all cardiovascular risk factors.