Aspirin prescribing for primary prevention of cardiovascular disease in patients with type 2 diabetes; a review of practice at University Hospital Galway

Background: Individuals with type 2 diabetes (T2DM) are at increased risk of cardiovascular disease (CVD). Guidelines for antiplatelet use as primary prevention in T2DM vary. The 2019 American Diabetes Association (ADA) guidelines recommend aspirin in those with T2DM at increased risk of CVD aged #8805;50 years while the NICE guidelines do not recommend aspirin in T2DM without established CVD. We sought to determine aspirin prescribing practices for primary prevention in T2DM patients attending our local services. Methods In January 2019 we interrogated our electronic diabetes database (DIAMOND) to identify patients aged #8805;50 years with T2DM and without established CVD. Results A total of 868 patients were identified. Of these 375(43.2%) were on aspirin or anticoagulants. Those on aspirin or anticoagulants had a mean HbA1c of 56mmol mol. Of these 45(12%) were smokers, 93(24.8%) had microalbuminuria and 127(33.9%) had hypertension. 493(56.8%) patients were not on aspirin or anticoagulants. In the non- treated group the mean HbA1c was 58mmol mol, 34(6.9%) were smokers, 83(16.8%) had micro-albuminuria and 132(26.8%) had hypertension. Conclusion Reviewing this data we believe there is a significant percentage of T2DM patients attending our services with established risk factors for CVD who are not on antiplatelet therapy. This may in part reflect the current lack of international consensus on aspirin prescribing in T2DM. We recommended the establishment of a locally agreed protocol and education programme for aspirin prescribing in T2DM based on the 2019 ADA guidelines. We plan to re-audit its implementation in 2020.