Endocrine Abstracts

Background: Type 1 diabetes mellitus (T1DM) is associated with high cardiovascular risk. Statins reduce the risk of non-fatal myocardial infarction when used as a primary prevention in selected patients with T1DM. A 2020 audit of statin prescription in our department showed 28.3% of patients who met criteria were on statin therapy. The aim of this quality improvement project was to improve statin prescription in eligible patients presenting to our outpatient diabetes department.

Methods: A printed proforma based on NICE 2023 guidelines was introduced to accompany patient diabetes data records. Clinical staff were educated on how to use the proforma and there was an accompanying supplementary tool with further instructions if required. We then prospectively collected data over two cycles from July to August 2023 and January to April 2024. Results of the first cycle were presented at departmental meetings prior to cycle two.

Results: Overall, 155/363(42%) of patients were already on statin therapy. Over the two cycles, 33/248 (13%) of patients were commenced on statin therapy. 110/248 (44%) were not started on a statin, this was appropriate in 88/110 (80%) patients. Therefore 33/55 (60%) patients meeting criteria were started on cholesterol lowering therapy. The most common reasons for not starting statin therapy were not meeting clinical criteria 50/108 (46%), patient declined 26/108 (24%) and planning pregnancy/childbearing age 7/108 (6%). There was an increase in incomplete forms of (11/113) 10% from cycle 1 to (44/250) 18% in cycle 2.

Conclusion: This QIP led to an increase in statin prescription among eligible patients with T1DM in our department. While effective in achieving our aim, there were limitations (i) Not all patients meeting criteria were commenced on treatment (ii) the number of unfilled forms increased between cycles. Electronic records and mandatory completion may improve this.