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Observational Study
. 2021 Jan;23(1):39-48.
doi: 10.1111/dom.14180. Epub 2020 Sep 22.

Global patterns of comprehensive cardiovascular risk factor control in patients with type 2 diabetes mellitus: Insights from the DISCOVER study

Krishna K Patel  1   2 , Marilia B Gomes  3 , Bernard Charbonnel  4 , Hungta Chen  5 , Javier Cid-Ruzafa  6 , Peter Fenici  7 , Niklas Hammar  8 , Linong Ji  9 , Kevin F Kennedy  1 , Kamlesh Khunti  10 , Mikhail Kosiborod  1   2 , Stuart Pocock  11 , Marina V Shestakova  12 , Iichiro Shimomura  13 , Filip Surmont  14 , Hirotaka Watada  15 , Suzanne V Arnold  1   2
Affiliations
Observational Study

Global patterns of comprehensive cardiovascular risk factor control in patients with type 2 diabetes mellitus: Insights from the DISCOVER study

Krishna K Patel et al. Diabetes Obes Metab. 2021 Jan.

Abstract

Aim: To investigate global patterns of cardiovascular risk factor control in patients with type 2 diabetes mellitus (T2D).

Methods: DISCOVER is an international, observational cohort study of patients with T2D beginning second-line glucose-lowering therapy. Risk factor management was examined among eligible patients (ie, those with the risk factor) at study baseline. Inter-country variability was estimated using median odds ratios (MORs).

Results: Among 14 343 patients with T2D from 34 countries, the mean age was 57.4 ± 12.0 years and the median (interquartile range) duration of T2D was 4.2 (2.0-8.0) years; 11.8% had documented atherosclerotic cardiovascular disease (ASCVD). Among eligible patients, blood pressure was controlled in 67.5% (9284/13756), statins were prescribed in 43.7% (5775/13208), angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers were prescribed in 55.6% (5292/9512), aspirin was prescribed in 53.3% of those with established ASCVD (876/1645), and 84.4% (12 102/14343) were non-smoking. Only 21.5% of patients (3088/14343) had optimal risk factor management (defined as control of all eligible measures), with wide inter-country variability (10%-44%), even after adjusting for patient and site differences (MOR 1.47, 95% confidence interval 1.24-1.66).

Conclusion: Globally, comprehensive control of ASCVD risk factors is not being achieved in most patients, with wide variability among countries unaccounted for by patient and site differences. Better country-specific strategies are needed to implement comprehensive cardiovascular risk factor control consistently in patients with T2D to improve long-term outcomes.

Keywords: cardiac risk factors; global patterns; type 2 diabetes mellitus.

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Conflict of interest statement

K.K.P. received support from the National Heart, Lung, And Blood Institute of the National Institutes of Health under Award Number T32HL110837. B.C., M.B.G., L.J., K.K., M.K., S.P., M.S., I.S. and H.W. are members of the DISCOVER Scientific Committee and received financial support from AstraZeneca to attend DISCOVER planning and update meetings. H.C., P.F. and F.S. are employees of AstraZeneca. N.H. is a former employee of AstraZeneca. J.C.‐R. is an employee of Evidera. K.F.K. has no competing interests to disclose. B.C. has received payment from AstraZeneca, Boehringer Ingelheim, Lilly, Merck Sharp & Dohme, Novartis, Novo Nordisk, Sanofi and Takeda. M.B.G. has received honoraria from Merck‐Serono. L.J. has received honoraria from AstraZeneca, Bayer, Boehringer Ingelheim, Bristol‐Myers Squibb, Eli Lilly, Merck Sharp & Dohme, Novartis, Novo Nordisk, Takeda, Sanofi and Roche, and research support from AstraZeneca, Bristol‐Myers Squibb, Eli Lilly, Merck Sharp & Dohme, Novartis, Roche and Sanofi. K.K. has received honoraria from AstraZeneca, Boehringer Ingelheim, Eli Lilly, Janssen, Merck Sharp & Dohme, Novartis, Novo Nordisk, Sanofi, Takeda, Servier and Pfizer, research support from AstraZeneca, Boehringer Ingelheim, Eli Lilly, Merck Sharp & Dohme, Novartis, Novo Nordisk, Sanofi and Pfizer, and also acknowledges support from the National Institute for Health Research (NIHR) Applied Research and Care East Midlands and the NIHR Leicester Biomedical Research Centre. M.K. has received honoraria from Applied Therapeutics, AstraZeneca, Amgen, Bayer, Boehringer Ingelheim, Eisai, GlaxoSmithKline, Glytec Systems, Intarcia, Janssen, Novartis, Novo Nordisk, Merck (Diabetes) and Sanofi, and research support from AstraZeneca and Behringer Ingelheim. M.S. has received honoraria from AstraZeneca, Boehringer Ingelheim, Eli Lilly, Merck Sharpe & Dohme, Novo Nordisk, Sanofi and Servier, and research support from Novo Nordisk and Sanofi. I.S. has received honoraria from Astellas Pharma, AstraZeneca, Boehringer Ingelheim, Kowa, Merck Sharp & Dohme, Mitsubishi Tanabe Pharma, Novo Nordisk, Ono Pharmaceutical, Sanwa Kagaku Kenkyusho and Takeda Pharmaceutical, and research support from Astellas Pharma, AstraZeneca, Daiichi Sankyo, Eli Lilly, Japan Foundation for Applied Enzymology, Japan Science and Technology Agency, Kowa, Kyowa Hakko Kirin, Midori Health Management Centre, Mitsubishi Tanabe Pharma, Novo Nordisk, Ono Pharmaceutical, Sanofi, Suzuken Memorial Foundation and Takeda Pharmaceutical. H.W. has received honoraria from Astellas Pharma, AstraZeneca, Boehringer Ingelheim, Daiichi Sankyo, Dainippon Sumitomo Pharma, Eli Lilly, Kissei Pharma, Kowa, Kyowa Hakko Kirin, Merck Sharp & Dohme, Mitsubishi Tanabe Pharma, Novo Nordisk, Novartis, Ono Pharmaceutical, Sanofi, Sanwa Kagaku Kenkyusho and Takeda, and research support from Abbott, Astellas Pharma, AstraZeneca, Bayer, Benefit One Health Care, Boehringer Ingelheim, Bristol‐Myers Squibb, Daiichi Sankyo, Dainippon Sumitomo Pharma, Eli Lilly, Kissei Pharma, Kowa, Kyowa Hakko Kirin, Johnson & Johnson, Merck Sharp & Dohme, Mitsubishi Tanabe Pharma, Mochida Pharmaceutical, Nitto Boseki, Novartis, Novo Nordisk, Ono Pharmaceutical, Pfizer, Sanofi, Sanwa Kagaku Kenkyusho, Taisho Toyama Pharmaceutical, Takeda and Terumo Corp.

Figures

FIGURE 1
FIGURE 1
Variability among countries in optimal comprehensive cardiovascular risk factor control in patients with type 2 diabetes enrolled in the DISCOVER study. Median odds ratios (MORs) estimate the median value of the odds ratios from two patients with identical risk factors from two randomly selected countries. An MOR of 1 indicates no country‐level variation in cardiovascular risk factor control, with higher MORs representing increased variability in risk factor control due to country specific effect, independent of patient and site‐level differences
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