COORDINATE-DIABETES: Coordinated Care Approach Improves Prescription of Guideline-Recommended Therapies in T2D and ASCVD

A coordinated, multifaceted intervention approach to improve prescribing practices increased the likelihood that patients with type 2 diabetes (T2D) and atherosclerotic cardiovascular disease (ASCVD) would be prescribed three classes of guideline-recommended medications by more than fourfold, according to research from the COORDINATE-DIABETES trial, presented at ACC.23/WCC and simultaneously published in JAMA.

Neha J. Pagidipati, MD, MPH, FACC, et al., enrolled 1,049 patients (459 at 20 intervention clinics and 590 at 23 usual care clinics) in a cluster randomized trial whose median age was 70 years, with 32.2% women, 16.5% Black participants and 8.6% Hispanic participants. They sought to evaluate the effect of an intervention incorporating assessment, education and feedback on the prescription of three groups of guideline-recommended medications for patients with T2D and ASCVD: high-intensity statins, ACEIs or ARBs, and SGLT2 inhibitors and/or GLP1RAs.

Clinics in the intervention group collaborated to develop a clinic-specific analysis of barriers to care and defined a care pathway based on these barriers to care. They also received tools for coordinating care among clinicians, clinician-oriented education and monthly conference calls, patient-oriented educational materials and feedback on quality metrics showing how their prescribing habits compared with other clinics.

Researchers defined the primary outcome as the proportion of patients prescribed all three groups of therapies at six to 12 months after enrollment, which was reached in 37.9% of those in the intervention group and 14.5% in the control group, an absolute difference of 23.4% (adjusted odds ratio, 4.38; 95% CI, 2.49-7.71; p<0.001). The difference was primarily driven by a large increase in prescriptions for SGLT2 inhibitors and GLP1RA drugs.

A composite secondary outcome of all-cause death or hospitalization for myocardial infarction, stroke, decompensated heart failure or urgent revascularization was observed in 5% of the intervention group and 6.8% of the usual care group (adjusted hazard ratio, 0.79; 95% CI, 0.46-1.33).

“As important as it is to develop new therapies, it is at least as important, if not more important, to focus on actually getting those therapies to the patients who need them,” said Pagidipati. “This study proves that the prescription of these medications can be substantially improved, and we know that more use of these medications will prevent cardiovascular events.”

Clinical Topics: Diabetes and Cardiometabolic Disease

Keywords: ACC Annual Scientific Session, ACC23, Cardiovascular System, Metabolic Syndrome

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