Coordinated, multifaceted intervention improves uptake of cardiopreventive therapies in T2D

The implementation of a coordinated, multifaceted intervention helps increase the prescription of three groups of evidence-based cardiopreventive therapies in adults with type 2 diabetes (T2D) and atherosclerotic cardiovascular disease (CVD), according to a study.

The study included 1,049 participants (median age 70 years, 32.2 percent women, 16.5 percent Black) who were not already taking the following groups of therapies: (1) high-intensity statins, (2) angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs), and (3) sodium-glucose cotransporter 2 (SGLT2) inhibitors and/or glucagon-like peptide 1 receptor agonists (GLP-1RAs).

The patients were randomly assigned to receive either the intervention (n=459) or usual care per practice (n=590). Specifically, the intervention involved assessing local barriers, developing care pathways, coordinating care, educating clinicians, reporting data back to the clinics, and providing tools for participants.

The primary outcome of the proportion of participants prescribed all three groups of recommended therapies at 12 months after enrolment was significantly greater in the intervention group than in the usual care group (37.9 percent vs 14.5 percent; adjusted odds ratio [OR], 4.38, 95 percent confidence interval [CI], 2.49–7.71; p<0.001).

Moreover, the intervention increased the likelihood of prescription of each of the three groups of therapies compared with usual care (high-intensity statins: adjusted OR, 1.73, 95 percent CI, 1.06–2.83; ACEIs or ARBs: adjusted OR, 1.82, 95 percent CI, 1.14–2.91; SGLT2 inhibitors and/or GLP-1RAs: adjusted OR, 3.11, 95 percent CI, 2.08–4.64).

The intervention had a null effect on atherosclerotic CVD risk factors.

Meanwhile, the composite secondary outcome (changes in atherosclerotic CVD risk factors and a composite outcome of all-cause death or hospitalization for myocardial infarction, stroke, decompensated heart failure, or urgent revascularization) occurred in 5 percent of the participants in the intervention group vs 6.8 percent in the usual care group (adjusted hazard ratio, 0.79, 95 percent CI, 0.46–1.33).