Duke specialists working independently to treat patients with diabetes, cardiovascular disease, kidney and liver disease, and related comorbidities have joined forces to create a distinctive multidisciplinary clinic dedicated to the challenges of cardiometabolic disease.
Patients with multiple conditions, often associated with diabetes or cardiovascular disease, must organize regular visits to primary care, cardiology and endocrinology. Many require additional consults with nephrologists, hepatologists, and related specialists.
Managing multiple risk factors is challenging because of the need to collaborate with multiple specialists, says Neha J. Pagidipati, MD, MPH, a cardiologist who leads the new Duke Cardiometabolic Prevention Clinic.
“For patients who need this level of comprehensive, coordinated care, we know that a multidisciplinary clinic offers a more effective model,” Pagidipati says.
“Our patients typically have many uncontrolled risk factors contributing to chronic conditions that can be difficult to manage within a single clinic or specialty,” Pagidipati says. “By working with their primary care doctors and approaching the care of these patients as a team, we are more effective. The patients are happier. Clinicians are happier, too, because they are more satisfied with the care they are providing. Most important, we expect the health of our patients to improve.
The clinic includes several cardiologists, an endocrinologist, nephrologist and hepatologist, as well as several advanced practice providers. Future plans call for the addition of dieticians and mental health care coordinators.
Clinic provides education, lifestyle guidance and medication monitoring
The clinic addresses cardiometabolic disease by providing education, promoting lifestyle changes, prescribing and monitoring medications and side effects, and ordering diagnostic tests. The clinic treats patients with the following risk factors:
- Obesity and related weight-management issues.
- Uncontrolled high cholesterol, including statin intolerance, as well as the potential use of PCSK-9 inhibitors for patients requiring higher-intensity cholesterol medication.
- Uncontrolled or hard-to-control type 2 diabetes mellitus (T2DM).
- Resistant hypertension.
- Resistant dyslipidemia.
- Nonalcoholic fatty liver disease.
Care for patients with metabolic disease has always been managed by multiple specialists, Pagidipati says. “In daily practice, this has been going on for years with shared consults,” she adds. “But this is the first clinic I’m aware of that brings the specialties together to create a single space for provider and patient convenience.”
The coordinated care philosophy ensures that the metabolic team develops personalized treatment approaches that often involve new therapies emerging from clinical trials and research. While the time lag between trial results and new guideline recommendations can stretch to decades, Pagidipati and her colleagues bring new approaches to patients more rapidly.