HMG Co-A reductase inhibitor medication management in American Indians with type 2 diabetes: A multiyear view from a rural tribal health system.

BACKGROUND

American Indian peoples have the highest prevalence of diabetes among all racial and ethnic groups. Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of morbidity and mortality in people with type 2 diabetes. Lipid management, including statin medications, is recommended to reduce the risk of ASCVD for patients with type 2 diabetes.

OBJECTIVES

We described statin medication dispensing patterns and analyzed adherence trends by age group and intensity of statin therapy within the Choctaw Nation Health Services Authority (CNHSA) type 2 diabetes patient population. Our second objective was to compare the frequency and timing of lipid panels to current guidelines.

METHODS

This was a retrospective secondary analysis of CNHSA electronic health record data from 2017 to 2021 of patients who used CNHSA services and pharmacies. The adherence analysis included patients who were dispensed statins for >180 days. Patients were stratified based on age and statin intensity. The lipid panel analysis included labs obtained yearly and 4-12 weeks after a statin adjustment.

RESULTS

Of the 8330 CNHSA patients with diabetes medication, 69.6% were prescribed a statin. Of those, 45.0% were dispensed moderate-intensity statins exclusively; 23.7% were on high-intensity statins only. The age <40 years group had the lowest adherence with mean proportion of days covered 0.69 (0.22). Yearly labs were completed for 85% of the patients in year 1 after first statin dispense and 80%, 77%, and 71% in subsequent years. Of the patients with adjustments, 13% had a follow-up lipid panel within 4-12 weeks after the first adjustment.

CONCLUSION

Statin medications were used by a large percentage of CNHSA patients with type 2 diabetes. Statin adherence was lowest in the younger age groups (<40). Our findings provide insight into statin use, adherence, and laboratory findings. Future studies should examine barriers to adherence specific to the larger CNHSA population.