Clinical Vigilance, Collaboration Keys to Outcomes

Lifesaving drugs essential for patients with diabetes, cardiovascular disease

Illustration of heart

An analysis of insured patients with both type 2 diabetes mellitus (T2DM) and atherosclerotic cardiovascular disease (ASCVD) identified gaps in care that contribute to poor outcomes and greater morbidity. The study was published in January 2021 in the Journal of the American Heart Association.

Duke cardiologist Christopher B. Granger, MD, senior author of the large study and a member of the Duke Clinical Research Institute (DCRI), says outcomes, including survival, could be substantially improved with clinical vigilance and collaboration among physicians to ensure patients receive these treatments, including cardiologists, who may defer starting these drugs to endocrinologists.

The sample of 155,958 patients with T2DM and ASCVD insured by Anthem, Inc. demonstrated that 24.7% of patients were using a high‐intensity statin, 53.1% were using an angiotensin‐converting enzyme inhibitor or angiotensin receptor blocker, and 9.9% were using either a sodium glucose cotransporter‐2 inhibitor or a glucagon‐like peptide‐1 receptor.

Each of these drugs has received the highest guideline recommendation for improved outcomes. But less than 3% of the population use all three drugs, demonstrating an enormous opportunity to improve care. Anthem is the largest for-profit managed health care company in the Blue Cross Blue Shield Association.

ASCVD is twice as common in patients with T2DM, contributing to greater morbidity and more frequent premature death. Professional societies recommend an aggressive approach to ASCVD risk reduction among patients with T2DM.

“We estimated that approximately 4,500 events could be prevented in this sample over three years,” with optimizing use of these drugs, says Granger, noting that stroke and myocardial infarction were common outcomes. “Patients may not want to take more drugs, but we need to explain the need for these treatments more effectively.”

The analysis analyzed outcome gaps between existing versus optimal treatments that are proven to prevent major cardiac events in people with T2DM and ASCVD, Dr. Neha Pagidipati, another DCRI cardiologist leading this analysis, says. “We know that one of the major epidemics in the U.S. and around the world is diabetes, and the primary cause of death from diabetes is heart disease.”

“The message to clinicians is that if you have a patient who has diabetes and cardiovascular disease, whether you are a primary care or cardiology physician, get them started on these drugs,” Granger adds. “Do not defer this decision to someone else. You have an enormous opportunity to improve the care of your patients by making sure they are taking these drugs.”

Drs. Granger and Pagidipati and a DCRI research team launched a related study in 2019 to assess outcomes among patients with T2DM and cardiovascular disease at more than 40 randomized cardiology clinics in the U.S. The clinic-level educational intervention will assess strategies to develop cardiology and endocrinology partnerships to improve patient care. The trial data analysis will review outcomes for more than 1,000 patients who are receiving collaborative care from specialists.