Factors associated with statin prescription patterns among type 2 diabetes mellitus attending diabetic clinic at Muhimbili National Hospital, Dar es salaam, Tanzania

Abstract

Background: It is undeniable that statins are under-prescribed despite being essential drugs for prevention of cardiovascular diseases among diabetes patients. Currently in Tanzania there is scarcity of data on this subject. Objectives: To describe statin prescription patterns and associated factors among type 2 diabetic patients attending the diabetic clinic at Muhimbili National Hospital in Dar es Salaam, Tanzania. Methodology: A Hospital based cross-sectional study was conducted at Muhimbili National Hospital diabetic clinic from September to November 2020. Data obtained from type 2 diabetes patients attending diabetes outpatient monthly clinic until the target of 395 patients was reached. A structured questionnaire was used to collect socio-demographic characteristics such as age, sex, level of education, occupation, health insurance status ,clinical characteristics including laboratory parameters, risks factors such as diabetes duration, history of cigarette smoking, hypertension, chronic kidney disease and presence of comorbidities. Statin prescription history (both type and dosage) was obtained from patients as well as from the electronic medical records for determination of patterns. Data analysis was done using IBM SPSS version 23. Descriptive statistics were presented in proportions and means ± sd. Inter-group comparisons were performed using chi square test. Logistic regression was used to examine for associations and control confounders and effect modifiers whereby p value of < 0.05 was considered statistically significant. Results: The mean (SD) age of the study participants was 58.1±10.3 years, out of which 371(93.9%) were aged ≥40 years. Two-thirds, 241(61.0%) of the patients were females. Half of the patients, 208(52.7%) had elementary to primary education. About two-third 257(69.4%) of patients had health insurance coverage. Among 400 patients who were approached for the study 395(98.8%) were eligible for statin prescriptions. Proportion of statin prescription was 47.3%. Moderate intensity statin was the only pattern found. Statin prescription was significantly greater among patients attended by endocrinologists (66.1%) compared with general practitioner (n=33.9%). Atorvastatin was prescribed in 95% and rosuvastatin in 5%. On univariate analysis: age>40years, diabetes duration, insurance coverage, hypertension, high LDL levels and proteinuria were found to be associated with moderate intensity statin pattern. In the adjusted model, insurance coverage (OR: 9.34; 95%CI: 4.63–18.85), hypertension (OR: 2.00; 95%CI: 1.04–3.86), and proteinuria (OR: 3.91; 95%CI: 1.30–11.74) were associated with an increased likelihood of moderate intensity pattern. Conclusion: A significant number of patients at MNH diabetic clinic were not on statins despite qualifying for the prescription. Moderate intensity statins was the only pattern found. Worryingly, over half of high risk group of patients were not receiving statins at all. The findings call for further studies on reasons for low statin prescription practices in this tertiary facility. Future studies should also explore on awareness of clinicians to recommended evidence based treatment patterns and other factors driving their prescription practice to this group of patients.