Determinants of inertia with lipid-lowering treatment in patients with type 2 diabetes mellitus

Objective: To assess the control of cLDL in diabetic patients, to measure the impact on such control of inertia with lipid-lowering agents and to explore factors that allow for predicting this inertia. Methods: Study of historical cohorts of diabetic patients. The proportion of patients who achieved the target cLDL levels was estimated. Therapeutic inertia was considered when the dose of the lipid-lowering agents was not adjusted, or a lipid-lowering agent was not changed or added in patients with initial cLDL outside the target. Change in cLDL from the first to the last visit and inertia with lipid-lowering drugs were analyzed according to comorbidities, cardiovascular risk factors and treatments used. Results: The study simple consisted of 639 patients (mean follow-up time 11.1 +/- 11.2 months), of whom 27.5% achieved target cLDL levels. Inertia occurred in 43,6% of patients with initial cLDL outside the target. Independent predictors of inertia were the initial cLDL (P < 0.001), polyneuropathy (P = 0.014), adjustment of antihypertensive agents (P = 0.002), adequacy of lipid-lowering agents (P < 0.001), use of ezetimibe (P = 0.001) and adherence to lipid-lowering drugs (P = 0.015). Conclusions: Inertia with lipid-lowering agents in a diabetic patient is less frequent in the presence of higher cLDL values, in cases of polyneuropathy, when antihypertensive agents are adjusted or changed, and when non-adherence is detected. The adequate initial prescription of statins and the association with ezetimibe decrease the likelihood of committing inertia. (C) 2018 SEEN y SED. Publicado por Elsevier Espana, S.L.U. All rights reserved