Cardioprotective measures neglected in young-onset type 2 diabetes
medwireNews: People with type 2 diabetes, especially young people, do not receive treatment for hypertension and dyslipidemia in a timely manner, even when they have high cardiovascular risk, study results show.
This clinical inertia “resulted in very high clinically unacceptable blood pressure and lipid burden over two years,” the researchers reported in a poster session at the virtual 56th EASD Annual Meeting.
Joanna Ling (Royal Melbourne Institute of Technology, Victoria, Australia) and colleagues used The Health Improvement Network (THIN) database to identify UK residents diagnosed with type 2 diabetes who also had high systolic blood pressure (SBP), elevated low-density lipoprotein cholesterol, or reduced non-high-density lipoprotein cholesterol, defined by standard or more rigorous thresholds according to the absence or presence, respectively, of atherosclerotic cardiovascular disease. For example, the SBP threshold was 140 mmHg without and 130 mmHg with accompanying vascular disease.
The team identified a total of 167,896 people with hypertension in addition to their diabetes, and more than 80% were at high cardiovascular risk due to existing disease or the presence of risk factors such as smoking and obesity.
Despite this high risk, it was a median of approximately 20 months before people aged 40 years or older started a new antihypertensive medication. And the delay to treatment was even more striking in people aged 18–39 years, with those at high cardiovascular risk waiting a median of 28 months and those at lower risk waiting a median of 31 months.
There was a similar pattern for the 168,365 people in need of lipid-lowering medications, with the older age groups receiving their first prescriptions after around 9–13 months, whereas the youngest group waited a median of 20 and 27 months if they had high and low cardiovascular risk, respectively.
During 2 years of follow-up, people who had not received blood pressure or lipid-lowering medications within a year of requiring them were significantly less likely to achieve control of these risk factors than those who had received treatment in a more timely fashion. This was the case across all age groups and was independent of factors including age, sex, baseline SBP and lipid levels, and mental illness.
“Our findings suggest revisiting the guidelines for proactive management of hypertension and dyslipidaemia in people with early-onset [type 2 diabetes],” the researchers concluded.
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