Multidisciplinary Approach Improves Care for Patients With Type 2 Diabetes, Heart Disease

A multidisciplinary approach to treatment that involves cardiologists, diabetes specialists, and other team members notably increases the prescription of evidence-based therapies for patients with type 2 diabetes (T2D) and atherosclerotic cardiovascular disease (ASCVD), according to data presented at the 83rd Scientific Sessions of the American Diabetes Association in San Diego, California.

In the United States, up to two-thirds of patients with T2D develop ASCVD, more commonly known as heart disease. ASCVD is linked with worse outcomes in patients with diabetes, and evidence-based therapies that reduce heart disease risk in diabetic patients are underutilized. In the COORDINATE-Diabetes trial, researchers sought to analyze the utility of a coordinated, multifaceted intervention of assessment, education, and feedback compared with usual care in adult patients with T2D.

The randomized clinical trial comprised 43 cardiology clinics across the United States. The clinics enlisted 1049 participants, 459 at 20 intervention clinics and 590 at 23 usual care clinics. The median patient age was 70 years, 32.2% of patients were women, and 16.5% were Black. Patients had been diagnosed with T2D and ASCVD and were not already taking all 3 groups of evidence-based therapies, including high-intensity statins, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and sodium-glucose cotransporter 2 inhibitors and/or glucagon-like peptide 1 receptor agonists. The study’s primary end point of interest was defined as the proportion of participants prescribed all 3 groups of recommended therapies at 6 to 12 months following trial enrollment.

Successful Intervention

The study showed that coordinated care intervention notably enhanced the quality of care that high-risk patients received. The researchers observed that individuals in the intervention arm were 4.38-fold more likely to be prescribed all 3 recommended classes of evidence-based therapies versus the standard care arm. “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,” said Neha Pagidipati, MD, MPH, an associate professor of medicine at Duke University School of Medicine, in a press release. “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.”