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Daily Dose: Coordinated Care to Optimize CV Preventive Therapies in T2D


Patient Care brings primary care clinicians a lot of medical news every day—it’s easy to miss an important study. The Daily Dose provides a concise summary of one of the website's leading stories you may not have seen.

On March 7, 2023, we reported on a study abstract presented at the American College of Cardiology’s (ACC) 2023 Annual Scientific Session Together with the World Congress of Cardiology and published simultaneously online in JAMA.

The study

Researchers hypothesized that a multifaceted intervention that included assessment, education, and feedback would lead to an increase in prescribing for the 3 classes of guideline-directed medical therapies (GDMT). They tested the hypothesis in COORDINATE (Coordinating Cardiology Clinics Randomized Trial of Interventions to Improve Outcomes)-Diabetes, a cluster randomized clinical trial conducted at 43 US cardiology clinics with participants recruited from July 2019 to May 2022 and follow-up continuing through December 2022.

Investigators randomized the clinics to the intervention or usual care. The study intervention comprised 6 components on which clinic personnel were trained by a group of 3 study clinicians (the trial trio)—a cardiologist, endocrinologist, and implementation specialist:

  • A clinic-specific analysis of the barriers to evidence-based care

  • Development of local interdisciplinary care pathways to address barriers.

  • Coordination of care between clinicians (cardiologists, endocrinologists, primary care clinicians)

  • Clinician education with a focus on current clinical guidelines, evidence for use of the 3 drug classes, and implementation of treatment in clinical care.

  • Audit and feedback of quality metrics on treatment at home clinic as well as at other intervention clinics.

  • Participant educational materials on GDMT and rationale for treatment

Clinics in the usual care group were provided with current clinical practice guidelines from the American College of Cardiology/American Heart Association and the American Diabetes Association on the management of type 2 diabetes (T2D) and atherosclerotic cardiovascular disease (ASCVD). A total of 1049 participants with T2D and ASCVD comprised the final cohort. Among them, 459 were recruited from 20 intervention clinics and 590 were recruited from 23 usual care clinics.

According to study findings, an absolute increase of 23.4% in prescriptions for all 3 recommended categories (ie, high-intensity statins, ACE inhibitors or ARBs, and sodium-glucose cotransporter 2 [SGLT2] inhibitors and/or glucagon-like peptide 1 receptor agonists [GLP-1RAs]) in the intervention vs the usual care group was “more than twice the improvement the trial was designed to detect,” according to study authors.

Note from authors

"A coordinated, multifaceted intervention increased prescription of 3 groups of evidence-based therapies in adults with type 2 diabetes and atherosclerotic cardiovascular disease."

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