3E-05 - Optimising lipid monitoring interval for primary prevention of cardiovascular diseases in patients with type-2 diabetes: a target trial emulation study

Background: There is limited evidence on risk-based strategies for long-term lipid monitoring in type 2 diabetes mellitus (T2DM) that meet patient needs while optimizing the allocation of healthcare resources.

Objectives: To determine the longest lipid monitoring intervals for primary prevention of cardiovascular diseases (CVD) without significantly increasing the long-term risk, in T2DM patients at different LDL-C levels.

Methods: T2DM adults without CVD from 2009 to 2012 were identified using centralised public electronic medical records from Hong Kong. Subjects were classified into three groups based on baseline LDL-C levels ( < 1.8, 1.8-2.59, and ≥2.6 mmol/L). A target trial was emulated within each group based on the clone-censor-weight approach to compare the impact of various lipid profile monitoring intervals (i.e. frequent monitoring: every 2-8 months, annual monitoring: every 9-15, less frequent monitoring: every 16-24 months) on the risk of all-cause mortality, CVD, and subtypes of CVD. Pooled logistic regression was performed to estimate hazard ratios (HRs) with 95% confidence intervals (CI). Follow-up began from baseline until the earliest occurrence of the outcome, death, or the cohort administrative end (December 31, 2021).

Results: A total of 153,341 patients were identified. For those with LDL-C < 1.8 mmol/L, extending the lipid profile monitoring interval to every 16-24 months did not increase the risk of all-cause mortality or CVD compared to every 2-8 months (adjusted HR [95% CI]: all-cause mortality: 1.094 [0.948, 1.263], CVD: 1.002 [0.846, 1.187]). Patients with LDL-C between 1.8-2.59 mmol/L had significantly higher all-cause mortality risks if their lipid profiles were monitored every 16-24 months rather than 2-8 months (adjusted HR [95% CI]: all-cause mortality: 1.154 [1.069, 1.245]). For patients with LDL-C ≥2.6 mmol/L, monitoring every 9-15 months was associated with increased risks of all-cause mortality and CVD, compared to monitoring every 2-8 months (adjusted HR [95% CI]: all-cause mortality: 1.263 [1.174, 1.359], CVD: 1.060 [1.017, 1.105]).

Conclusions: For T2DM patients with LDL-C < 1.8 mmol/L, the lipid profile monitoring interval can be extended to every 16-24 months. Patients with LDL-C between 1.8-2.59 mmol/L and ≥2.6 mmol/L should be monitored at least every 9-15 months and 2-8 months, respectively.