Underuse of Medications and Lifestyle Counseling to Prevent Cardiovascular Disease in Patients With Diabetes

Cardiovascular disease (CVD) accounts for ≥75% of hospitalizations and >50% of all deaths among patients with diabetes (1,2). Guideline-directed therapies for patients with diabetes aged 50 years and older with an additional cardiovascular risk factor such as hypertension include cardioprotective medications (antiplatelet therapy, statins, and antihypertensives shown to reduce cardiovascular events) and lifestyle counseling for healthy behaviors (weight loss/diet, exercise, and smoking cessation) (1,3). However, data are limited on trends in usage of pharmacotherapies and lifestyle counseling for patients with diabetes at increased CVD risk. Therefore, we used nationally representative data to investigate trends in medication use and lifestyle counseling among U.S. outpatients aged 50 years and over with diabetes and hypertension.All visits to office-based physicians and hospital-based clinics by adults (aged 50 years and older with hypertension; N = 14,096 visits) from 2006 to 2015 in the National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS) were included. Data include patient symptoms, comorbidities, and demographics; physician diagnoses; medications ordered or provided; and medical services provided. Diabetes and hypertension were identified using ICD-9-Clinical Modification diagnosis codes. Physician decision making and treatment were evaluated using 1 ) Multum Lexicon drug codes/categories and generic codes for antiplatelet agents (aspirin and clopidogrel), …