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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 change...

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Autores principales: Fadini, Gian Paolo, Frison, Vera, Simioni, Natalino, Lapolla, Annunziata, Gatti, Adriano, Bossi, Antonio Carlo, Del Buono, Andrea, Fornengo, Paolo, Gottardo, Lucia, Laudato, Mario, Perseghin, Gianluca, Bonora, Enzo, Avogaro, Angelo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6662129/
https://www.ncbi.nlm.nih.gov/pubmed/31269877
http://dx.doi.org/10.1161/JAHA.119.012244
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author Fadini, Gian Paolo
Frison, Vera
Simioni, Natalino
Lapolla, Annunziata
Gatti, Adriano
Bossi, Antonio Carlo
Del Buono, Andrea
Fornengo, Paolo
Gottardo, Lucia
Laudato, Mario
Perseghin, Gianluca
Bonora, Enzo
Avogaro, Angelo
author_facet Fadini, Gian Paolo
Frison, Vera
Simioni, Natalino
Lapolla, Annunziata
Gatti, Adriano
Bossi, Antonio Carlo
Del Buono, Andrea
Fornengo, Paolo
Gottardo, Lucia
Laudato, Mario
Perseghin, Gianluca
Bonora, Enzo
Avogaro, Angelo
author_sort Fadini, Gian Paolo
collection PubMed
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 A(1c), 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 A(1c) 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.
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spelling pubmed-66621292019-08-02 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 Fadini, Gian Paolo Frison, Vera Simioni, Natalino Lapolla, Annunziata Gatti, Adriano Bossi, Antonio Carlo Del Buono, Andrea Fornengo, Paolo Gottardo, Lucia Laudato, Mario Perseghin, Gianluca Bonora, Enzo Avogaro, Angelo J Am Heart Assoc Original Research 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 A(1c), 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 A(1c) 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. John Wiley and Sons Inc. 2019-07-04 /pmc/articles/PMC6662129/ /pubmed/31269877 http://dx.doi.org/10.1161/JAHA.119.012244 Text en © 2019 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
spellingShingle Original Research
Fadini, Gian Paolo
Frison, Vera
Simioni, Natalino
Lapolla, Annunziata
Gatti, Adriano
Bossi, Antonio Carlo
Del Buono, Andrea
Fornengo, Paolo
Gottardo, Lucia
Laudato, Mario
Perseghin, Gianluca
Bonora, Enzo
Avogaro, Angelo
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 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 Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6662129/
https://www.ncbi.nlm.nih.gov/pubmed/31269877
http://dx.doi.org/10.1161/JAHA.119.012244
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