Dr Jennifer Green Emphasizes Managing Traditional Risk Factors, Overcoming Clinical Inertia in Patients With Diabetes

Jennifer Green, MD, an endocrinologist and clinical trialist at Duke University, stresses the need to prescribe high-risk patients with diabetes or established cardiovascular disease medications that reduce future cardiovascular or kidney events.

Additionally, she highlights the revolution in diabetes care driven by new clinical trial outcomes, but she also emphasizes the need to manage traditional risk factors, like glucose and blood pressure. Lastly, despite improved medication access due to generic formulations, Green notes that clinical inertia remains a major treatment barrier.

This transcript has been lightly edited for clarity.

Transcript

What is the importance of having medications for patients with diabetes that have cardiovascular and kidney benefits?

The guidelines are very, very clear that high-risk individuals, such as those with diabetes and established cardiovascular disease, need to include in their regimen at least one type of medication to reduce their risk of future cardiovascular and/or kidney events; I think it's of critical importance. The outcomes data from the large clinical trials are very convincing, and diabetes care has been completely revolutionized by this new information.

At the same time, we can't forget that we need to continue to focus on traditional modifiable risk factors, like glucose, for example, in people with diabetes. Blood pressure, lipids, and smoking cessation all matter.

What are the barriers to getting these medications with additional cardiovascular and kidney benefits to patients?

The traditional answer as to why high-risk patients aren't receiving these indicated medications is that patients can't access them, but that's clearly not the only reason. Fortunately, access should become easier as generic formulations of SGLT2 [sodium-glucose cotransporter-2] inhibitors and GLP-1 [glucagon-like peptide 1] receptor agonists become available.

But there is a significant component of clinical inertia that can be multifactorial, even when patients have clear access to medications. So, again, each local clinic or practice probably has its own barriers, some of these might be providers' understanding of the changes in the guidelines, and that would need to be tackled first. For others, it might just be a need to take a more systematic approach to deficiencies in care that are then systematically approached.