In 138 adults with type 2 diabetes attending a Barranquilla cardiology clinic (mean age 67, 72% male), 70.3% had HbA1c above 7%. Poorer control tracked with higher LDL cholesterol (124.9 vs 106.0 mg/dL), cerebrovascular disease (11.3% vs none), and more echocardiographic abnormalities. SGLT2 inhibitors were documented in only 16.7% of patients and were less common in the poorly controlled group, but that link vanished after adjustment (OR 0.56, 95% CI 0.20-1.58). Each 10 mg/dL of total cholesterol raised the odds of HbA1c above 7% by 10%.
The most useful number here is the 16.7% SGLT2 inhibitor rate. Trials such as EMPA-REG, DAPA-HF and DECLARE showed these drugs cut heart failure hospitalization and cardiovascular risk, and guidelines recommend them for diabetic patients with established cardiovascular disease regardless of HbA1c. Finding them prescribed to so few patients in a specialist cardiology setting points to a treatment gap, likely driven by cost and access. The study cannot say why, and the null adjusted result mostly reflects a small sample. Design limits are substantial: a single center, cross-sectional data, a lone HbA1c value, and an exploratory model with wide confidence intervals, so causal claims are off the table. The cholesterol association is plausible, since diabetic dyslipidemia and poor glycemic control cluster together, but it is correlational. Readers with diabetes and heart disease should ask their doctor whether their LDL, HbA1c and SGLT2 eligibility have been reviewed. Overall this is confirmatory regional evidence of a known care gap, not a new discovery.