Lipid Control and Factors Associated with LDL-C Control among patients with Type 2 Diabetes Mellitus on Statins in Western Kenya

Abstract

Background: Dyslipidemia is the presence of abnormal blood lipid parameters, characterized by increased LDL-C, triglycerides, and total cholesterol but reduced HDL-C. It is a common finding in patients with T2DM, occurring at a prevalence rate of between 70% and 85%, and promotes the development of long-term cardiovascular complications, which are the leading cause of mortality in this population. Statins are the first-line drugs, but lipid control varies from patient to patient despite being widely used. Objective: To assess lipid control and the factors associated with LDL-C control in patients with type 2 DM who are on statins at a national referral hospital in Western Kenya. Methods: A retrospective study on 211 patients with type 2 DM who had been on a statin for at least three months. Data was obtained from patient records and lipid measures categorized as controlled or uncontrolled based on the Kenya National Guidelines for the Management of Diabetes Mellitus, 2018. Chi- square and Fischer’s exact test determined the association between variables. A multivariate logistic regression model was fit for variables significant at the bivariate level, and a P value of <0.05 was considered significant. Results: Most (99%) were on a single lipid-lowering drug, mainly atorvastatin, and 92% were on moderate-intensity dosing. Regarding lipid control, 50.3% had uncontrolled LDL-C, 30% had uncontrolled HDL-C, and 47% had uncontrolled triglyceride levels. Being on a high-intensity statin increased the likelihood of LDL-C control compared to moderate-intensity dosing (OR 8.57 [95% CI 4.3-16.9, P<0.001]). Conclusion: LDL-C was the most poorly controlled parameter. Patients on high-intensity statins had better LDL-C control; therefore, high-intensity statin therapy should be initiated in diabetic patients who do not achieve their LDL-C targets.