Spotlight on undertreatment of risks from diabetes

Studies published in the past month looked at statin prescriptions for patients with diabetes and osteoporotic fracture risk in women with diabetes.

Recent studies highlighted the cardiovascular and osteoporotic risks of diabetes and offered evidence that patients could be receiving greater preventive treatment.

The first study, a research letter published in the Journal of the American College of Cardiology on Sept. 12, assessed statin use among more than 215,000 patients between the ages of 40 and 75 years. Overall, statins were prescribed to 61.6% of patients with diabetes. For about 62,000 patients, data on LDL cholesterol levels were available, and only 57.7% of them had a level below 100 mg/dL (<2.6 mmol/L). The study found significant practice-level variation in the prescription of statins after controlling for a number of patient-related factors, “suggesting that practice- or provider-related factors primarily determined variation in statin use,” the authors said. They noted that the study was limited by the possibility of suboptimal documentation in some practices but concluded that identifying the reasons behind higher statin prescription rates at some practices than others could improve statin use among high-risk patients.

The other study looked at fracture risk among women ages 40 years and older; results were published in the Journal of Clinical Endocrinology and Metabolism on Sept. 7. Almost 50,000 women without diabetes were compared to 8,840 with diabetes. The study found that having diabetes for at least 10 years was associated with a significantly higher risk for major osteoporotic fracture, even after adjustment with the WHO Fracture Risk Assessment (FRAX) tool. Having diabetes for any amount of time was associated with an increased risk for hip fracture, with the risk increasing as the duration of diabetes did. The results show that the FRAX underestimates fracture risk among women who have had diabetes for at least 10 years, the authors concluded. Type 2 diabetes of this duration should be considered a red flag for osteoporosis, perhaps equivalent to a previous fracture, they advised.