APPROPRIATENESS OF GUIDELINE-RECOMMENDED STATIN THERAPY AND LDL-C GOAL ATTAINMENT AMONG PATIENTS WITH TYPE 2 DIABETES MELLITUS IN AN INDONESIAN PRIMARY CARE CLINIC

Ula, Zahrotul and Aditama, Lisa (2027) APPROPRIATENESS OF GUIDELINE-RECOMMENDED STATIN THERAPY AND LDL-C GOAL ATTAINMENT AMONG PATIENTS WITH TYPE 2 DIABETES MELLITUS IN AN INDONESIAN PRIMARY CARE CLINIC. MAHESA: Malahayati Health Student Journal, 7 (1). ISSN 2746-3486 (In Press)

PDF REPOSITORY ZAHROTUL ULA.pdf - Accepted Version Download (345kB)

Abstract

Introduction: Patients with type 2 diabetes mellitus (T2DM) have a substantially increased risk of developing atherosclerotic cardiovascular disease (ASCVD). Current clinical guidelines recommend statin therapy according to cardiovascular risk stratification to reduce LDL-C levels and prevent cardiovascular events. However, evidence regarding the appropriateness of statin therapy and LDL-C goal attainment in Indonesian primary care settings remains limited, particularly in the context of National Formulary (Formularium Nasional/Fornas) policy constraints. Purpose: To evaluate the appropriateness of statin therapy according to current clinical guideline recommendations and assess LDL-C goal attainment among patients with type 2 diabetes mellitus at a primary care clinic. Method: A retrospective observational study was conducted using medical records of 270 T2DM patients aged ≥40 years with complete lipid profile data at Primary Care Clinic "X" between January 2025 and April 2026. Cardiovascular risk was assessed using the ASCVD Risk Estimator and stratified according to the Indonesian Society of Cardiology (PERKI) 2022 guideline. Statin therapy appropriateness was evaluated based on the ADA 2026, ACC/AHA 2018, and PERKENI 2024 guidelines, while LDL-C goal attainment was assessed according to cardiovascular risk category. Result: Of 270 patients, the mean age was 60.7 ± 7.9 years, and 63.3% were female. Based on ASCVD risk stratification, 196 patients (72.6%) were recommended to receive high-intensity statins, and 74 patients (27.4%) were recommended to receive moderate-intensity statins. However, only 60 patients (22.2%) received any statin therapy — all simvastatin, predominantly at 10 mg (low-intensity). No patient received high-intensity statin therapy (0%). LDL-C goals were achieved in only 22 patients (8.1%), with the lowest attainment in the very high-risk group (target <55 mg/dL: 0.9%). Conclusion: A substantial gap exists between guideline-recommended statin therapy and actual prescribing practice in primary care, with extremely low LDL-C goal attainment. This gap is attributed to structural barriers from the National Formulary policy, therapeutic inertia, and limited clinical pharmacist involvement. National Formulary reform based on cardiovascular risk stratification and strengthened roles of clinical pharmacists in medication review and therapy advocacy are urgently needed to improve ASCVD prevention in T2DM patients.

Item Type:	Article
Uncontrolled Keywords:	ASCVD, LDL-C, primary care, statin, type 2 diabetes mellitus
Subjects:	R Medicine > RM Therapeutics. Pharmacology
Divisions:	Faculty of Pharmacy > Department of Pharmacy
Depositing User:	ZAHROTUL ULA
Date Deposited:	03 Aug 2026 08:59
Last Modified:	03 Aug 2026 08:59
URI:	http://repository.ubaya.ac.id/id/eprint/51089

Actions (login required)

View Item