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Chekol Tassew W, Ferede YA, Zeleke AM. Prescribing patterns of statins and associated factors among type 2 diabetes mellitus patients in Africa: A systematic review and meta-analysis. Metabol Open 2024; 23:100297. [PMID: 39006881 PMCID: PMC11246013 DOI: 10.1016/j.metop.2024.100297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Revised: 06/19/2024] [Accepted: 06/19/2024] [Indexed: 07/16/2024] Open
Abstract
Background In sub-Saharan African nations, there's a documented shortfall in the utilization of statins, despite established clinical guidelines advocating their use for reducing cardiovascular risks and overall mortality among Type 2 diabetes patients aged 40-75 years old. Most clinical guidelines recommend prescribing statins to individuals with type 2 diabetes to reduce the chances of cardiovascular disease. There is currently a lack of extensive research on statin utilization specifically for primary prevention of cardiovascular disease in Africa. Thus, this study aimed to assess the prescription patterns of statins for preventing cardiovascular disease in type 2 diabetes patients. Methods The findings of the review were presented following the guidelines outlined in the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA-2020) checklist. We conducted searches on electronic databases including PubMed, EMBASE, Cochrane Library, Science Direct, African Journal Online, and Google Scholar. This systematic review and meta-analysis included articles that met specific inclusion criteria: observational studies such as cross-sectional, cohort, and case-control studies focusing on determinants, risk factors, or correlates associated with statin prescription within Africa. Only published articles up to June 2, 2024, published in English, and conducted in either community or healthcare facility settings were considered. Data import was initially conducted using Microsoft Excel, and statistical analysis was performed using STATA software. Cochran's Q test was employed to assess whether there was a significant variance in prevalence among the studies. Additionally, the I2 statistic was utilized to quantify the extent of heterogeneity. A funnel plot, a visual tool, was utilized to evaluate publication bias. Results The search strategy resulted in 7695 published original articles. The full texts of the 89 papers were assessed for eligibility and quality. Moreover, some articles were rejected due to inaccuracies in the outcome variable. Ultimately, only ten studies focusing on the prevalence of statin prescription were examined. The research suggests that the pooled prevalence of statin prescription among Type 2 diabetic individuals in Africa is found to be 48.82% (95% CI: 35.41-63.24). Age greater than 65 years (AOR = 3.56, 95% CI: 1.70-7.45; I2 = 54.7%), comorbidity (AOR = 1.13, 95% CI: 0.27-4.63, I2 = 96.4%), dyslipidemia (AOR = 3.15, 95% CI: 1.54-6.44, I2 = 61.7%), DM duration greater than ten years (AOR = 1.36, 95% CI: 0.81-2.28, I2 = 77.3%), and government insurance (AOR = 8.85, 95% CI: 2.72-28.76, I2 = 81.5%) were factors associated with statin prescription among type 2 diabetic patients. Conclusions In general, the extent of statin prescriptions for individuals with type 2 diabetes who are eligible for statin therapy was below the target outlined by clinical practice guidelines. Being over 65 years old, having comorbidities, experiencing dyslipidemia, having type 2 diabetes for more than ten years, and having government insurance were all identified as independent factors predicting the prescription of statins. This finding is concerning and underscores the urgent need to enhance adherence to clinical practice guidelines for the well-being of this vulnerable population at high risk.
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Affiliation(s)
- Worku Chekol Tassew
- Teda Health Science College, Department of Medical Nursing, Gondar, Ethiopia
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Bullock JE. Provider adherence to American Diabetes Association cardiovascular risk-reduction guidelines: An integrative review. J Am Assoc Nurse Pract 2024; 36:17-22. [PMID: 37494065 DOI: 10.1097/jxx.0000000000000920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 06/05/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND Diabetes mellitus (DM) requires comprehensive management to prevent end organ disease. Type 2 diabetes Mellitus (T2DM) effects more than 33.3 million individuals in the United States, the majority managed by primary care providers (PCPs). Type 2 diabetes Mellitus increases lifetime heart attack and stroke risk by 2-4 times. Adherence to the American Diabetes Association (ADA) cardiovascular disease reduction guidelines is associated with decreased morbidity and mortality. PURPOSE This integrative review highlights PCP adherence to ADA cardiovascular risk-reduction guidelines and explores interventions that address adherence. METHODOLOGY The integrative review approach demanded critical examination of the literature following extraction of findings obtained through a rigorous process involving clear inclusion and exclusion criteria. A comprehensive literature search was guided through Johns Hopkins Nursing Evidence-Based Practice Model. Data extraction was documented through Preferred Reporting Items for Systematic Reviews and Meta-Analysis. RESULTS Five articles met inclusion criteria. Articles ranged from 2017 to 2022 and occurred in the United States, Palestine, and one across Europe. Four areas of common content were identified and included the lack of adherence to statin prescribing, lack of adherence to blood pressure management, statin prescribing favoring male patients and those with existing atherosclerotic cardiovascular disease diagnoses, and varying methods to improve adherence. CONCLUSIONS Quality-improvement strategies focused on the improvement of PCP adherence to ADA cardiovascular risk-reduction guidelines are necessary. IMPLICATIONS Improved adherence would significantly improve morbidity and mortality outcomes in T2DM. Adherence interventions include education, electronic health record integration, and oversight by certified diabetes educator nurses. The time is now to reduce the negative sequelae from a disease that effects 11.3% of our population.
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Affiliation(s)
- Jamie Eve Bullock
- Johns Hopkins University School of Nursing, Baltimore, Maryland
- University of New England, Portland, Maine
- Martin's Point Health Care, Portland, Maine
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Ekpor E, Akyirem S, Adade Duodu P. Prevalence and associated factors of overweight and obesity among persons with type 2 diabetes in Africa: a systematic review and meta-analysis. Ann Med 2023; 55:696-713. [PMID: 36821504 PMCID: PMC9970251 DOI: 10.1080/07853890.2023.2182909] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Type 2 diabetes and obesity are serious public health concerns globally and a growing burden in Africa. Both conditions have serious repercussions on health when they co-occur, yet the extent of their co-occurrence in Africa remains unknown. Therefore, this review aimed to identify the prevalence and associated factors of overweight and obesity among persons with type 2 diabetes in Africa. METHOD A systematic search was conducted on PubMed, MEDLINE, Embase, African Index Medicus (AIM), and African Journals Online (AJOL) for observational studies that reported the prevalence of overweight and/or obesity among type 2 diabetes patients in Africa. The prevalence data from individual studies were aggregated through a random-effects meta-analysis. The I2 statistic was used to evaluate between-studies heterogeneity, while subgroup analysis and mixed-effects meta-regression were performed to identify sources of heterogeneity. We assessed publication bias using funnel plots and Egger's test. This review adhered to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. RESULTS Of 1753 records retrieved, 80 articles were eligible for this review, with 74 cross-sectional studies included in the meta-analysis. The pooled prevalence of overweight and obesity was 35.6% and 25.6% respectively, while the overall prevalence of both overweight and obesity was 61.4%. Also, the pooled prevalence of both overweight and obesity across the five geographical areas in Africa ranged from 56.9% in East Africa to 88.5% in Southern Africa. Nineteen factors were significantly associated with overweight and obesity among patients with type 2 diabetes. CONCLUSION The high prevalence of overweight and obesity among patients with type 2 diabetes is a significant public health concern that transcends geographical boundaries within Africa. The findings from this review highlight the need for innovative weight management interventions that are tailored to the cultural context of the African setting.KEY MESSAGESThere was a high prevalence of overweight and obesity among the type 2 diabetes patients.Nineteen factors were identified to be significantly associated with overweight and obesity among type 2 diabetes patients.Only 12 out of the 80 included studies primarily focused on the prevalence of overweight and/or obesity which reflects a dearth of interest in this topic.
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Affiliation(s)
- Emmanuel Ekpor
- School of Nursing, University of Ghana, Legon, Ghana.,St. Martins de Porres Hospital, Eikwe, Ghana
| | - Samuel Akyirem
- Yale School of Nursing, Yale University, New Haven, CT, USA
| | - Precious Adade Duodu
- Department of Nursing and Midwifery, School of Human and Health Sciences, University of Huddersfield, England, UK
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Melaku EE, Ayele ET, Urgie BM, Ayidagnuhim GB, Hassen EM, Tefera AS. Appropriate Use of Primary Statin Preventive Therapy Among Patients with High Atherosclerosis-Related Cardiovascular Disease Risks: Cross-Sectional Study, Northeast Ethiopia. Vasc Health Risk Manag 2023; 19:707-718. [PMID: 37954557 PMCID: PMC10638903 DOI: 10.2147/vhrm.s435036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 10/31/2023] [Indexed: 11/14/2023] Open
Abstract
Background Atherosclerosis-related cardiovascular diseases (coronary heart diseases, ischemic stroke, and peripheral vascular diseases) account for the majority of deaths in diabetic and other high-risk patients. Statin therapy reduces major vascular events, coronary death or nonfatal myocardial infarction, coronary revascularization, and ischemic stroke. However, a gap exists between guideline recommendations and the clinical practice of primary statin preventive therapy. This was a cross-sectional study that aimed to determine the prevalence and some associated risk factors of. Purpose This study was intended to assess the magnitude of primary statin preventive therapy and associated factors among patients with high atherosclerosis-related cardiovascular disease risks. Patients and Methods An institutional-based cross-sectional study design was conducted by a consecutive sampling technique from February 1, 2023, to May 30, 2023. Face-to-face interviews using a structured questionnaire, document review, and laboratory measurements were implemented to collect data. Data entered into Epi Data were analysed by STATA version 14 and summarized by using frequency tables and graphs. Binary and multivariate logistic regression analyses were performed and checked for association at a p value of <0.05. Results A total of 389 patients were included in this study. Diabetes mellitus (43.75%), hypertension (47.3%), and chronic kidney disease (9.25%) were commonly identified diseases. One hundred sixty-seven (42.93%, CI: 38.07-47.92) patients with high atherosclerosis-related cardiovascular disease (ASCVD) risks were on primary statin preventive therapy. Duration of diabetes mellitus (AOR=1.33, CI: 1.1569-1.528), treating physician (AOR=3.875, CI: 1.368-10.969), follow-up regularity (AOR=3.113, CI: 1.029-9.417) and ten-year atherosclerosis-related cardiovascular disease risk score (AOR=1.126, CI: 1.021-1.243) were found to be significantly associated with the use of primary statin preventive therapy. Conclusion and Recommendations The magnitude of patients who were on primary statin preventive therapy was relatively low (42.93%). Improving the regular follow-up and making senior physicians (internists) attend patients at medical follow-up clinics would likely improve the number of patients who are on primary statin preventive therapy.
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Affiliation(s)
- Ermiyas Endewunet Melaku
- Department of Internal Medicine, school of Medicine, Debre Berhan University, Debre Berhan, Ethiopia
| | - Esubalew Tesfahun Ayele
- Department of Epidemiology, School of Public Health, Debre Berhan University, Debre Berhan, Ethiopia
| | - Besufekad Mulugeta Urgie
- Department of Internal Medicine, school of Medicine, Debre Berhan University, Debre Berhan, Ethiopia
| | | | - Erzik Mohammed Hassen
- Department of Internal Medicine, school of Medicine, Debre Berhan University, Debre Berhan, Ethiopia
| | - Aklile Semu Tefera
- Department of Epidemiology, School of Public Health, Debre Berhan University, Debre Berhan, Ethiopia
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Nigussie S, Demeke F. Prescribing patterns of statins and associated factors among type 2 diabetes mellitus patients attended at Jugol General Hospital in eastern Ethiopia: A cross-sectional study. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2023; 4:1061628. [PMID: 37034477 PMCID: PMC10076854 DOI: 10.3389/fcdhc.2023.1061628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 02/24/2023] [Indexed: 04/11/2023]
Abstract
Background Most clinical practice guidelines support the use of statins in patients with type 2 diabetes mellitus to lower the risk of cardiovascular disease. However, nothing is known about the prescribing patterns of statins at Jugol General Hospital in eastern Ethiopia. Objective This study aimed to assess the prescribing patterns of statins and associated factors among type 2 diabetes mellitus patients attended at Jugol General Hospital in eastern Ethiopia. Methods A retrospective cross-sectional study was conducted among 423 patients with type 2 diabetes mellitus who received follow-up care from 1 June 2017 to 1 June 2022. The study participants were enrolled consecutively using a convenience sampling technique. The data were extracted from patients' medical records using a data abstraction checklist. The extracted data were entered into EpiData, version 3.1, and exported to Statistical Package for the Social Sciences (SPSS), version 22, for analysis. Associations were considered to be statistically significant at a p-value < 0.05 and presented as adjusted odds ratios and 95% confidence intervals. Result The medical records of 423 patients were reviewed. The review revealed that medical records were complete for 410 of these patients, and these records were included in the analysis. The majority of the study participants were female (72.2%) and between the age of 40 and 65 years (61.2%). All of the study participants were eligible for statin prescription; however, statins were prescribed for only 257 (62.7%) study participants. Of the statins prescribed, moderate-dose-intensity statins were prescribed for 40 (15.6%) participants who were at high risk of cardiovascular disease. Atorvastatin was the most commonly (93.3%) prescribed statin. The presence of hypertension, coronary artery disease, and cerebrovascular events was significantly associated with statin prescribing. Conclusion The magnitude of prescribing statins for patients with type 2 diabetes mellitus was low in comparison with the clinical practice guidelines recommendation. This finding is alarming and is a call for action to improve the execution of clinical practice guidelines for the benefit of this high-risk population.
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Affiliation(s)
- Shambel Nigussie
- Department of Clinical Pharmacy, School of Pharmacy, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
- *Correspondence: Shambel Nigussie,
| | - Fekade Demeke
- Department of Epidemiology, College of Medicine and Health Sciences, Jigjiga University, Jigjiga, Ethiopia
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Al Souheil F, Chahine B. Statin Prescription Patterns Among Elderly Patients with Type 2 Diabetes: A Cross-Sectional Study in Lebanon. Drugs Real World Outcomes 2022; 10:159-166. [PMID: 36422816 PMCID: PMC9944594 DOI: 10.1007/s40801-022-00335-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Even though statins have been proven to be effective in both primary and secondary prevention of cardiovascular disease among diabetic patients, a suboptimal use of the latter has been detected in real clinical practice, especially among older adults. OBJECTIVE This study aimed to evaluate the patterns and predictors of statin use among elderly patients with type 2 diabetes mellitus (T2DM) in Lebanon. METHODS This is a cross-sectional study that extended between April 2021 and February 2022. Our study involved elderly T2DM outpatients, aged 65-80 years, who presented to 40 community pharmacies for prescription filling. Diabetes status was ascertained via dispensed medication information, and patients were classified based on the American Diabetes Association preset risk scores for cardiovascular diseases in diabetics: low, moderate, or high risk. The questionnaire included patients' demographics, clinical information, and status of statin use. RESULTS A total of 420 diabetic geriatric patients were observed in this study; their mean age was 70 years (± 7), and there was a predominance of males, 270 (64.3%). Almost all patients were classified as being at high risk, 396 (94.3%), while the rest were at moderate risk; thus, all were recommended to receive statins; however, statin prescription was only reported among 197 (46.9%), with atorvastatin and rosuvastatin being the most used: 102 (51.8%) and 62 (31.5%), respectively. Of patients prescribed statins, 60 (14.3%) were taking them for primary prevention and 137 (32.6%) for secondary prevention. Patients having a higher Charlson Comorbidity Index score had lesser odds of being prescribed statins (odds ratio [OR] 0.15, 95% confidence interval [CI] 0.02-0.8, p = 0.028); however, those presenting with a history of dyslipidemia and coronary artery disease had higher odds of statin prescription (OR 10.5, 95% CI 4.2-26.1, p < 0.001, and OR 5.0, 95% CI 2.4-10.5, p < 0.001, respectively). CONCLUSION Despite patients' eligibility to receive statins, statin undertreatment was evident among elderly outpatients with T2DM in Lebanon, which was modulated by several predictors.
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Affiliation(s)
- Farah Al Souheil
- grid.444421.30000 0004 0417 6142PharmD program, School of Pharmacy, Lebanese International University, Beirut, Lebanon
| | - Bahia Chahine
- PharmD program, School of Pharmacy, Lebanese International University, Beirut, Lebanon.
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Moeed A. Liver Enzymes and Non-Alcoholic Fatty Liver Disease: Important Factors in Assessing Patterns of Clinical Management in Type-2 Diabetes Patients [Letter]. Diabetes Metab Syndr Obes 2022; 15:777-778. [PMID: 35300188 PMCID: PMC8922321 DOI: 10.2147/dmso.s363684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 03/05/2022] [Indexed: 01/21/2023] Open
Affiliation(s)
- Abdul Moeed
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
- Correspondence: Abdul Moeed, Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan, Tel +92 3061159372, Email
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Bideberi AT, Mutagaywa R. Statin Prescription Patterns and Associated Factors Among Patients with Type 2 Diabetes Mellitus Attending Diabetic Clinic at Muhimbili National Hospital, Dar es Salaam, Tanzania [Response to Letter]. Diabetes Metab Syndr Obes 2022; 15:1111-1112. [PMID: 35437347 PMCID: PMC9013249 DOI: 10.2147/dmso.s368402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 03/29/2022] [Indexed: 12/03/2022] Open
Affiliation(s)
- Aneth Telesphore Bideberi
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Department of Internal Medicine, Muhimbili National Hospital, Dar es Salaam, Tanzania
- Correspondence: Aneth Telesphore Bideberi, Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, P. O. Box 65001, Dar es Salaam, Tanzania, Tel +255 759334883, Email
| | - Reuben Mutagaywa
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Department of Internal Medicine, Muhimbili National Hospital, Dar es Salaam, Tanzania
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