Coordinated Care Significantly Improves Treatment Quality for Patients With T2D, Heart Disease

New research shows that a coordinated care approach involving collaboration among cardiologists, diabetes specialists, and other health care professionals can significantly improve care quality for patients with both type 2 diabetes (T2D) and atherosclerotic cardiovascular disease (ASCVD), or heart disease.

These late-breaking findings come from the COORDINATE-Diabetes trial and were presented today at the American Diabetes Association (ADA) 83rd Scientific Sessions in San Diego, California.

According to an ADA press release, nearly two-thirds of individuals with T2D eventually develop ASCVD in the United States. Additionally, patients with T2D and the heart condition are more likely to have poorer health outcomes compared with patients without diabetes. Despite this known association, there is an underutilization of evidence-based therapies in clinical practice to reduce heart disease risk in adults with T2D.

“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,” Neha Pagidipati, MD, MPH, associate professor of medicine at Duke University School of Medicine, said in the press release.

In response to this issue, the COORDINATE-Diabetes trial aimed to evaluate the impact of a coordinated, multifaceted intervention on the prescription rates of 3 recommended evidence-based therapies for individuals with both T2D and ASCVD. The trial’s primary objective was to determine the proportion of participants who were prescribed all 3 groups of therapies within 6 to 12 months after enrollment.

The randomized clinical trial enrolled 1049 participants with both T2D and ASCVD from 43 cardiology clinics across the United States. Of this group, 459 participants were at 20 intervention clinics and 590 participants were at 23 standard care clinics. The median age was 70 years, and the study included 338 women (32.2%), 173 Black participants (16.5%), and 90 Hispanic participants (8.6%).

Participants were eligible if they had not already received all 3 groups of evidence-based therapies:

• High-intensity statins
• Angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs)
• Sodium-glucose cotransporter 2 (SGLT2) inhibitors and/or glucagon-like peptide 1 receptor agonists (GLP-1RAs)

The results indicated a significant improvement in the quality of care for patients with T2D and heart disease who received coordinated care.

During the last follow-up visit, patients at the intervention clinics were 4.38 times more likely to receive all 3 recommended groups of therapies compared with patients at standard care clinics.

Specifically, 37.9% of patients in the intervention group had been prescribed all 3 classes, whereas only 14.5% of patients in the standard care group had received the same level of treatment. Additionally, participants in the intervention arm were more than 3 times more likely to be prescribed an SGLT2 inhibitor and/or GLP-1RA.

While the study was not specifically designed to measure differences in clinical outcomes, it is worth noting there was a 21% relative risk decrease in the composite outcome of all-cause death or hospitalization for myocardial infarction, stroke, decompensated heart failure, or urgent revascularization. However, this decrease was not statistically significant.

“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,” Pagidipati said.