Treatment patterns for chronic venous disease and diabetes mellitus: lessons from an international market-research survey

Juan Rosas-Saucedo, Detelina Lukanova, Frederic Glauser, Jose Luis Salazar, Milena Staneva, A. Kursat Bozkurt, Juan Rosas-Guzman, Sherif Sholkamy & Giacomo Gastaldi*

Objective: The enormous burden of chronic venous disease among the general population is often overlooked, especially in the context of multi-morbidity. The aim of this study was to assess comorbidity of the pathologically-related conditions chronic venous disease and diabetes mellitus (DM).

Methods: Data were derived from a quantitative market-research survey of physicians in Brazil, Mexico, Turkey, Bulgaria, Switzerland and Egypt (June-July 2019). Generalists and specialist with 3–30 years in practice; ≥ 10 chronic venous insufficiency (CVI) patients per week; and ≥ 1 CVI patient receiving pharmacotherapy were eligible. Interviews assessed practice details, patient population and anonymised data from one patient each treated for CVI, CVI and DM, and CVI and DM with microvascular complications (DmVC).

Results: Over half of patients (53%) with CVI had comorbid DM. DM was likely to be diagnosed first followed by CVI (mean gap 5.3 years) and finally DmVC (mean gap 3.4 years). Patients being treated for CVI alone were diagnosed at an earlier CEAP stage (C2: 34.5%) than those being treated CVI+DM (C2: 24.8%) or CVI+DmVC (C2: 17.8%). A large minority (25.0– 29.3%) of patients self–medicated when presenting with CVI symptoms. Compression with pharmacotherapy was the most common initial treatment in all groups (39.3–42.3%). Most patients in all groups received initial diagnosis and treatment by non–specialists (54.4– 55.4%).

Conclusion: There is a substantial unmet therapeutic need in CVI patients and those with comorbid DM are more likely to be untreated for longer. Earlier specialist intervention may improve care in this population.