ADA 2023 NEWS: Coordinated care approach improves care for people with type 2 diabetes and heart disease
Multi-disciplinary care between cardiologists, diabetes specialists and other team members can increase the prescriptions of evidence-based therapies to help treat people with both type 2 diabetes and heart disease, findings from the COORDINATE-Diabetes trial demonstrate.
In the United States alone, up to two-thirds of people with type 2 diabetes develop heart disease in their lifetime.
While heart disease is associated with worse health outcomes in people with diabetes compared to the general population, evidence-based therapies to reduce heart disease risk in adults with type 2 diabetes are underused in clinical practice.
The goal of this study was to evaluate if a coordinated, multifaceted intervention of assessment, education, and feedback versus usual care of adults with type 2 diabetes would impact the prescription of three recommended evidence-based therapies, designed to help treat individuals with both diseases.
The randomised clinical trial – which was presented at the 83rd Scientific Sessions of the American Diabetes Association® (ADA) – included 43 cardiology clinics across the U.S.
The clinics enrolled 1,049 participants (459 at 20 intervention clinics and 590 at 23 usual care clinics) with 2 diabetes and heart disease not already taking all three groups of evidence-based therapies, including high-intensity statins, angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs), and sodium-glucose cotransporter 2 (SGLT2) inhibitors and/or glucagon-like peptide 1 receptor agonists (GLP-1Ras).
The median age was 70 years and there were 338 women, 173 Black participants, and 90 Hispanic participants. The primary outcome was the proportion of participants prescribed all three groups of recommended therapies at six to 12 months after enrolment.
Findings show that coordinated care intervention can significantly improve the quality of care that high risk patients receive.
At the last follow-up visit, those in the intervention arm were 4.38-fold more likely to be prescribed all three recommended classes vs. the standard care arm.
A total of 37.9 per cent of those in the intervention arm had been prescribed all three classes vs. 14.5 per cent in the standard care arm. In particular, those in the intervention arm were more than three-fold more likely to be prescribed an SGLT2 inhibitor and/or GLP-1RA.
While the study was not designed or powered to detect differences in clinical outcomes, 23 of 457 participants in the intervention group vs 40 of 588 participants in the usual care group experienced the composite outcome of all-cause death or hospitalisation for myocardial infarction, stroke, decompensated heart failure, or urgent revascularisation (21 per cent decrease in relative risk, not statistically significant).
“For patients with type 2 diabetes and heart disease, receiving the appropriate therapy is critically important for treatment and prevention, yet there is still a large gap in the number of patients actually receiving the treatment needed,” said Neha Pagidipati, MD, MPH, Associate Professor of Medicine at Duke University School of Medicine. “Our study shows us that by providing multifaceted interventions such as assessing local barriers and coordinating across clinicians and clinics, we can help increase the prescriptions of the therapies proven effective for patients with both type 2 diabetes and ASCVD.”
The authors note the implementation of coordinated interventions in clinics across the country will likely result in improved patient care and outcomes.