A coordinated, multifaceted intervention proved effective in increasing the prescription of three classes of guideline-recommended therapies in adults with type 2 diabetes (T2D) and atherosclerotic cardiovascular disease (ASCVD). This was found in the cluster randomized clinical trial COORDINATE-Diabetes, carried out in cardiology clinics across the US.
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. “These therapies are highly underused in clinical practice: 37.4% use none and only 2.7% take all three,” said Neha Pagidipati, MD, MPH, who presented the results at the American College of Cardiology 2023 Annual Scientific Sessions.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). Dr Pagidipati explained that clinics in the intervention group collaborated to develop a multifaceted intervention, which entailed:
- Assessment of local practices and barriers to prescribing recommended therapies
- Developing strategies to overcome these barriers
- Audit and feedback on quality metrics.
The study enrolled 1,049 patients, 459 of whom were treated in clinics (intervention group) and 590 of whom received usual care. The mean age was 70 and 32% were women. The primary outcome was the proportion of patients prescribed all three groups of therapies at 6-12 months after enrollment.
The primary endpoint was reached by 37.9% in the intervention group and 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 hospitalization for myocardial infarction, stroke, decompensated heart failure, or urgent revascularization 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). “The next step,” said Dr Pagidipati, “is to scale this intervention across cardiology practices to improve the quality of care being delivered broadly.”
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