An integrated, multidimensional approach to treatment can enhance diabetes and heart disease prevention
According to research being presented at the American College of Cardiology’s Annual Scientific Session Together With the World Congress of Cardiology, a multifaceted intervention to improve prescribing practices increased the likelihood that patients with Type 2 diabetes and heart disease would be prescribed three classes of medications that are recommended by guidelines by more than fourfold.
Preventive drugs are helpful at lowering sickness and premature death among people with Type 2 diabetes and heart disease, who have a high risk of major cardiac events. Few of these patients, however, receive all of the preventive drugs that are suggested by the guidelines and could be of use to them.
The investigation revealed atherosclerotic heart disease in those with Type 2 diabetes (heart disease related to blocked arteries). Angiotensin converting enzyme inhibitors/angiotensin receptor blockers (ACEi/ARBs), which lower blood pressure and protect the heart and kidneys, sodium glucose cotransporter-2 inhibitors (SGLT2i), or glucagon-like peptide-1 receptor antagonists, were the three classes of medication that the researchers randomly assigned to 43 participating cardiology clinics to improve prescription.
1,049 individuals with Type 2 diabetes and confirmed heart disease who were not initially prescribed all three medication classes visited participating clinics over the course of the trial. Nearly 38% of patients seen at clinics that received the tailored intervention had been prescribed all three medication classes at the final follow-up visit (which happened 12 months after the intervention in most patients), a significantly higher proportion than the 14.5% of patients in clinics receiving basic education who had been prescribed all three medication classes, meeting the trial’s primary endpoint.
The difference was driven primarily by a large increase in prescriptions for SGLT2i and GLP-1RA drugs, researchers said. While prescriptions for those drugs rose in both study groups (likely due to a change of guidelines during the study), the increase was far greater in clinics that received the tailored intervention.
Researchers said the customized nature of the intervention and the use of multiple components, rather than just one, likely contributed to the intervention’s success. They plan to make information about the intervention broadly available so that it can be adopted and scaled across health care settings.
While the trial was not designed to assess clinical benefits, researchers said the increased adoption of guideline-recommended best practices may help patients better manage their chronic conditions for better health in the long run.