Background and aims: Clinical trial evidence of the cardiovascular benefits of statins in type 2 diabetes has changed management substantially, especially over the last 10 years. To examine the magnitude and effects of this change in a real-world setting, we analysed data collected over almost 20 years as part of the Fremantle Diabetes Study (FDS), an observational study of diabetes in an urban Australian community. Our aim was to compare serum lipid profiles and use of lipid-modifying therapies in the 1,296 type 2 participants recruited to Phase 1 (FDS1) between 1993 and 1996 with those of the 1,509 type 2 participants from the same postcode-defined area recruited to Phase 2 (FDS2) between 2008 and 2011.

Materials and methods: Comprehensive questionnaire, physical and biochemical data were collected at baseline in both phases. Patients attended after a >10-hour overnight fast with biochemical testing of fasting blood and urine samples performed in a nationally-accredited laboratory using methods that were the same for both Phases or recalibrated when assays changed.

Results: FDS2 patients were older than those in FDS1 (mean 65.4±11.7 vs 64.0±11.3 years, P=0.001) but a similar proportion was male (51.8 vs 48.6%, P=0.10). Statin use was substantially greater in FDS2 (65.9 vs 6.8%, P<0.001) in association with a significantly lower serum LDL-cholesterol (2.3±0.9 vs 3.3±0.9 mmol/L, P<0.001), but there was no difference in serum HDL-cholesterol or triglycerides between phases (P>0.31). Serum LDL-cholesterol targets (<2.6 mmol/L in primary prevention, <1.8 mmol/L in secondary prevention) were met by 68.2% of statin-treated FDS2 patients. One third of FDS2 patients eligible for government-subsidised statin therapy remained untreated. Use of fibrate therapy remained low in FDS2 (2.2 vs 3.5%, P=0.05).

Conclusion: There has been a substantial increase in statin use by Australians with type 2 diabetes over the last two decades with most statin-treated patients achieving recommended LDL-cholesterol targets, but coverage remains incomplete. A low rate of fibrate use mirrors the comparatively weak evidence base for cardiovascular disease prevention in type 2 diabetes.