Multifaceted strategy improves prescription of therapies for diabetes and ASCVD

A coordinated, multifaceted intervention proved effective in increasing the prescription of 3 classes of guideline-recommended therapies in adults with type 2 diabetes (T2D) and atherosclerotic cardiovascular disease (ASCVD). This was found in the cluster randomised clinical trial COORDINATE-Diabetes, carried out in cardiology clinics across the USA.

High-intensity statins, angiotensin-converting enzyme (ACE) inhibitors/angiotensin receptor blockers (ACEi/ARBs), and sodium‐glucose cotransporter-2 inhibitors (SGLT2i) have been shown to improve outcomes for patients with T2D and ASCVD. Yet, “these therapies are highly underused in clinical practice: 37.4% use none and only 2.7% take all 3,” said study presenter Prof. Neha Pagidipati (Duke University Hospital, NC, USA) [1].

The COORDINATE-Diabetes study (NCT03936660) evaluated the effect of a clinic-level intervention that incorporated assessment, education, and feedback on the prescription of high-intensity statins, ACEi or ARBs, and SGLT2i and/or glucagon-like peptide 1 receptor agonists (GLP1RAs). Clinics in the intervention group collaborated to develop a multifaceted intervention (see Figure).

Figure: The multifaceted intervention of COORDINATE–Diabetes [1]



The study enrolled 1,049 patients, 459 of whom were treated in clinics in the intervention group and 590 received usual care. The mean age was 70 years, and 32% were women. The primary outcome was the proportion of patients prescribed all 3 groups of therapies at 6 to 12 months after enrolment.

The primary endpoint was reached by 173 out of 457 (37.9%) in the intervention group and 85 out of 588 (14.5%) in the control group; an absolute difference of 23.4% (adjusted OR 4.38; 95% CI 2.49– 7.71; P<0.001). Dr Pagidipati said this difference was primarily driven by a large increase in prescriptions for SGLT2i and GLP1RAs.

She added that the composite secondary outcome of all-cause death or hospitalisation for myocardial infarction, stroke, decompensated heart failure, or urgent revascularisation was reached by 5% in the intervention group and 6.8% in the control group (adjusted HR 0.79; 95% CI 0.46–1.33). “This difference is not statistically significant, but it is in line with what we would expect based on previously published data,” said Prof. Pagidipati. “The next step is to scale this intervention across cardiology practices to deliver high-quality care more broadly.”

1. Pagidipati N, et al. Coordinating Cardiology Clinics Randomized Trial Of Interventions To Improve Outcomes (COORDINATE) - Diabetes: Primary Results. Session 409-16, ACC Scientific Session 2023, 4–6 March, New Orleans, USA.

 

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Posted on 7 June, 202325 March, 2024