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Coordinated Care to Optimize Cardiovascular Preventive Therapies in Type 2 Diabetes A Randomized Clinical Trial

Coordinated Care to Optimize Cardiovascular Preventive Therapies in Type 2 Diabetes A Randomized Clinical Trial JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Pagidipati, N. J., Nelson, A. J., Kaltenbach, L. A., Leyva, M., McGuire, D. K., Pop-Busui, R., Cavender, M. A., Aroda, V. R., Magwire, M. L., Richardson, C. R., Lingvay, I., Kirk, J. K., Al-Khalidi, H. R., Webb, L., Gaynor, T., Pak, J., Senyucel, C., Lopes, R. D., Green, J. B., Granger, C. B., COORDINATE Diabet Site Investigators 2023; 329 (15): 1261-1270

Abstract

Evidence-based therapies to reduce atherosclerotic cardiovascular disease risk in adults with type 2 diabetes are underused in clinical practice.To assess the effect of a coordinated, multifaceted intervention of assessment, education, and feedback vs usual care on the proportion of adults with type 2 diabetes and atherosclerotic cardiovascular disease prescribed all 3 groups of recommended, evidence-based therapies (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]).Cluster randomized clinical trial with 43 US cardiology clinics recruiting participants from July 2019 through May 2022 and follow-up through December 2022. The participants were adults with type 2 diabetes and atherosclerotic cardiovascular disease not already taking all 3 groups of evidence-based therapies.Assessing local barriers, developing care pathways, coordinating care, educating clinicians, reporting data back to the clinics, and providing tools for participants (n?=?459) vs usual care per practice guidelines (n?=?590).The primary outcome was the proportion of participants prescribed all 3 groups of recommended therapies at 6 to 12 months after enrollment. The secondary outcomes included changes in atherosclerotic cardiovascular disease risk factors and a composite outcome of all-cause death or hospitalization for myocardial infarction, stroke, decompensated heart failure, or urgent revascularization (the trial was not powered to show these differences).Of 1049 participants enrolled (459 at 20 intervention clinics and 590 at 23 usual care clinics), the median age was 70 years and there were 338 women (32.2%), 173 Black participants (16.5%), and 90 Hispanic participants (8.6%). At the last follow-up visit (12 months for 97.3% of participants), those in the intervention group were more likely to be prescribed all 3 therapies (173/457 [37.9%]) vs the usual care group (85/588 [14.5%]), which is a difference of 23.4% (adjusted odds ratio [OR], 4.38 [95% CI, 2.49 to 7.71]; P?

View details for DOI 10.1001/jama.2023.2854

View details for Web of Science ID 000947152200001

View details for PubMedID 36877177

View details for PubMedCentralID PMC9989955