Are cholesterol medications overprescribed for patients with type 2 diabetes?
Researchers from the VA Ann Arbor Healthcare System (VAAAHS) and the University of Michigan Health System highlight the importance of taking an individualized approach when it comes helping people with diabetes minimize their risks for heart disease. Some patients with type 2 diabetes may not need high dose cholesterol lowering drugs that can have serious adverse effects.
Authors of a new study emphasize the potential harm that can come from exposing patients with type 2 diabetes to high dose medications that can lead to overtreatment and harm when a ‘one size fits all’ approach is used.
In their study, the researchers found nearly 14 percent of patients with diabetes; with no history of heart disease, may have been taking high dose cholesterol lowering medications known as statins that can cause muscle pain, liver damage, higher blood glucose levels, memory loss and liver disease.
Senior author Eve Kerr, M.D., director of the Center for Clinical Management Research at the VAAAHS, professor of internal medicine at the U-M Medical School and a member of the U-M Institute for Healthcare Policy and Innovation said in a press release, “We want patients to get the treatment they need to prevent heart attacks and cardiovascular issues but we don’t want to expose them to additional treatment risks without strong evidence of the benefits.”
The report that appears in the journal Cardiovascular Quality and Outcomes suggests physicians who want to deliver high quality care to patients with diabetes can become overly aggressive with prescribing medications by using a standardized approach instead of individual treatment.
“We need to move away from a one-size-fits-all performance measure that misses the point of providing appropriate treatment”, Kerr says.
People with diabetes over age 50 are especially at risk for heart disease. A common goal is to keep LDL cholesterol levels believed to promote atherosclerosis less than 100 mg/dl.
But the authors say there is recent evidence that not all people with diabetes need to keep cholesterol levels at a set value. Another recent study suggested not all type 2 diabetics carry the same risks for heart disease, supporting the notion that treatment for preventing heart disease complications should be based on individual risk factors.
“The study reveals that we may have both underuse and overuse of statins and should invigorate efforts to make sure that each patient has the opportunity to be treated in a personalized way that is best given their risk profile,” says Circulation Editor and Director of the Yale-New Haven Hospital Center for Outcomes Research and Evaluation Harlan M. Krumholz, M.D. in a media release.
The investigation included over 960,000 veterans with type 2 diabetes treated in primary care clinics from July 2010 to June 2011. Most of the patients were receiving appropriate treatment, but the author concluded "...many patients are potentially overtreated with high-dose statins."
The study authors say individualized treatment for cutting diabetes heart disease risks is possible because of access to patient health information with electronic medical records. The finding suggests it can be harmful for patients when doctors take a ‘one size fits all’ approach for prescribing statins for people with type 2 diabetes. The FDA recently issued new guidelines and warnings for cholesterol lowering drugs, based on concerns over side effects.
Circ Cardiovasc Qual Outcomes. 2012
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