GUIDELINE-DIRECTED LIPID GOAL ATTAINMENT IN PATIENTS WITH DIABETES AT HIGH AND VERY HIGH CARDIOVASCULAR RISK: REAL-WORLD EVIDENCE OF A PROFOUND TREATMENT GAP

Abstract

Objective: To evaluate lipid-lowering therapy patterns and the attainment of guideline-directed low-density lipoprotein cholesterol (LDL-C) and non-high-density lipoprotein cholesterol (non-HDL-C) goals among high and very high-risk patients with diabetes mellitus in a real-world clinical setting.Material and Methods: This retrospective observational study included 202 patients (197 with type 2 and 5 with type 1 diabetes mellitus). Patients were stratified into high-risk (HR, n=132) and very high-risk (VHR, n=70) categories according to cardiovascular risk criteria. Statin utilization, combination therapy rates, and target attainment frequencies (LDL-C <70 mg/dL for HR; <55 mg/dL for VHR) were analyzed based on current European guidelines.Results: Only 51.0% of the total cohort received statin therapy (50.0% in HR and 52.9% in VHR groups). Combination therapy was exceptionally rare (0 .5%, n= 1). LD L-C target attainment was ala rmingly low; merely 18.2% of HR patients a nd 1 0.0% o f V HR patients achieved th eir sp ecific goa ls. Amo ng patients actively treated with statins, attainment rates remained highly inadequate (19.7% in HR and 10.8% in VHR). Non-HDL-C goals were successfully reached by only 16.7% of HR and 11.4% of VHR patients.Conclusion: Guideline-directed lipid goal attainment i s critically suboptimal amo ng hig h and very high-risk diabetic patients. This profound treatment gap, likely driven by a complex interplay of physician-level therapeutic inertia and patient-level non-adherence or reluctance, highlights an urgent need for proactive, patient-centered, and protocol-driven lipid management.