TOPLINE:

Only around 40% of patients with type 2 diabetes (T2D) and incident cardiovascular comorbidities received treatment that fully adhered to guidelines for cardiovascular care. Those who adhered to these guidelines had lower risks for cardiovascular events and mortality than those who did not.

METHODOLOGY:

• Researchers in Germany conducted a retrospective observational study using claims data to characterise real-life treatment patterns in patients with T2D and cardiovascular comorbidity and to determine whether treatments aligned with national clinical guidelines.
• They identified 17,175 patients with T2D (mean age, 71.1 years; 41.8% women) who experienced an incident cardiovascular comorbidity between 2016 and 2018 and had at least 12 months of follow-up.
• Adherence to guidelines was assessed, and patients were categorised as those treated completely adherent, partly adherent, or non-adherent to guidelines on the basis of prescription patterns.
• Outcome measures included all-cause mortality and a modified three-point major adverse cardiovascular event (3P-MACE) composite endpoint, defined as all-cause death or an inpatient diagnosis of myocardial infarction or stroke.

TAKEAWAY:

• Renin-angiotensin-aldosterone system inhibitors (83.9%), diuretics (72.6%), and beta-blocking agents (71.8%) were the most frequently prescribed cardiovascular treatments during follow-up.
• Around 40% of patients received care completely adherent to the relevant cardiovascular guidelines, with the highest adherence observed in those with myocardial infarction.
• Non-adherence vs complete adherence to cardiovascular guidelines was associated with an increased risk for mortality (adjusted hazard ratio [aHR], 1.93; 95% CI, 1.65-2.25) and modified 3P-MACEs (aHR, 1.49; 95% CI, 1.31-1.69).
• Both survival and cardiovascular outcomes were also worsened in patients not treated according to current T2D guidelines.

IN PRACTICE:

"The results underline that inconsistent guideline adherence is associated with an increased risk of serious outcomes, including premature death," the authors wrote.

SOURCE:

This study was led by Jens Aberle, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany. It was published online on September 23, 2025, in Cardiovascular Diabetology.

LIMITATIONS:

Claims data may have misclassified adherence when therapy was withheld for intolerance or other clinical reasons. More severe cases might have been underrepresented due to the exclusion of patients who died within 30 days after the date of the first observed diagnosis of an incident cardiovascular comorbidity. The study included only the most common cardiovascular comorbidities.

DISCLOSURES:

This study was funded by Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany. Five authors reported being employees of the funding agency or of institutions contracted by the funding agency. Some authors reported receiving speaker's honoraria, consulting fees, grants, and personal fees and having other ties with several pharmaceutical companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.