Adherence to recent evidence-based guidelines for statin therapy in primary prevention for type 2 diabetes patients: A quality improvement initiative

Abstract

Background/Synopsis

Cardiovascular disease is the leading cause of morbidity and mortality in type 2 diabetes patients. The 2024 American Diabetes Association (ADA) guidelines recommend high-intensity statin therapy for individuals aged 40–75 with diabetes and elevated cardiovascular risk, aiming for a ≥50% LDL reduction and a target LDL of <70 mg/dL. Moderate-intensity therapy is advised if high-intensity therapy is contraindicated. Despite clear guidelines, gaps remain in adherence and achieving LDL goals, especially in high-risk outpatient populations.

Objective/Purpose

This quality improvement project aimed to assess adherence to the updated ADA guidelines for statin therapy in type 2 diabetes patients at Cooperman Barnabas Medical Center (CBMC). Objectives included evaluating whether statin prescriptions and dosages followed guidelines, checking LDL goal achievement, and documenting the use of cholesterol-lowering medications like statins, ezetimibe, and PCSK9 inhibitors.

Methods

A retrospective cohort of 50 adult patients with type 2 diabetes, aged 40 - 75, was selected from the CBMC clinic between June and December 2024. Patients with a history of major atherosclerotic cardiovascular disease were excluded. Adherence to the January 2024 ADA guidelines was assessed using data from Epic, including lipid panels, cholesterol-lowering medications, and ASCVD risk factors. LDL therapy was adjusted during clinical visits, with high-intensity statins initiated or escalated for patients not meeting LDL targets, and follow-up included lipid panels and visits to monitor efficacy and adherence.

Results

Among the cohort, 62% (31/50) did not achieve the LDL goal of < 70 mg/dL. Of the patients not meeting LDL goals, 83.9% were on high-intensity statins, 12.9% on moderate-intensity statins, and 3.2% were not on relevant therapy. Furthermore, 16.1% (5/31) of those not achieving LDL goals were eligible for statin therapy escalation, including four requiring a transition to high-intensity statins and one needing therapy initiation. Combination therapies, such as ezetimibe or PCSK9 inhibitors, were underutilized, with 80.6% (25/31) patients underutilizing both therapies. A substantial portion of the cohort exhibited multiple ASCVD risk factors, including hypertension, obesity, and chronic kidney disease (CKD), underscoring the high-risk nature of this population.

Conclusions

This initiative highlights the importance of adhering to guideline-based practices to improve cardiovascular outcomes in patients with type 2 diabetes. While statin therapy adherence is strong, gaps in achieving LDL goals point to the need for statin escalation, combination regimens, and enhanced follow-up care. Leveraging tools like Epic smart phrases can help standardize care delivery, identify patients requiring therapy intensification, and align clinical practices with evidence-based recommendations to reduce ASCVD risk and improve long-term outcomes.