Study shows ‘alarming gaps’ in treatment of patients with diabetes, heart disease

Tuesday, February 16, 2021
 Adam Nelson, MBBS, PhD

 Adam Nelson, MBBS, PhD

Over a third of patients with diabetes and heart disease were not taking any of the three therapies proven to prevent major adverse cardiovascular events.

Patients with Type 2 diabetes and atherosclerotic cardiovascular disease are at increased risk for cardiovascular events. However, less than 3 percent of this population are using the appropriate evidence-based therapies that would reduce this risk, according to findings from a recent analysis of pharmacy and insurance claims data.

The study, which was led by recently graduated DCRI fellow Adam Nelson, MBBS, PhD, and published in the Journal of the American Heart Association, examined prescriptions of three therapies: 1) high-intensity statin, 2) angiotensin-converting enzyme inhibitor (ACEi) or angiotensin-receptor blocker (ARB), and 3) a glucose-lowering therapy with cardiovascular benefit such as a sodium glucose co-transporter-2 inhibitor (SGLT-2i) or glucagon-like peptide-1 receptor agonist (GLP-1RA). Although evidence from clinical trials supports prescribing all three of these therapies to eligible patients, they are profoundly under-used in clinical practice. The findings from the sample of over 150,000 patients showed:

  • Only 25 percent of patients were using a high-intensity statin;
  • Just over half of patients were using an ACEi or ARB; and
  • Barely 10 percent of patients were using either an SGLT-2i or GLP-1RA.

The study team estimates that an increase in prescription of evidence-based therapies to 100 percent over three years could reduce future major adverse cardiovascular events by 4,546 events in this population of 150,000 patients.

 “This study points to gaps in care that we must address urgently to provide the best care for these patients who at high risk for morbidity and mortality,” Nelson said. “Barriers to 100 percent utilization of these therapies are present at the patient, clinician and system levels. Patients, providers, industry, regulators, professional societies, and payers all have a role to play in translating evidence to practice.”

Other notable findings from the study include:

  • Over the year prior, 70.6 percent of the cohort had seen a cardiologist, while only 18 percent had seen by an endocrinologist (and those who had seen an endocrinologist were more likely to be using SGLT-2is or GLP-1RAs). “This suggests that cardiologists, in addition to primary care providers, are well placed to close these gaps in care,” Nelson said.
  • The data reinforces the presence of gender disparities seen in other studies, with men more likely to be using evidence-based therapies. However, the study was not powered to determine whether this difference can be attributed to prescribing behavior, patient adherence, or a combination of the two.

Additional DCRI contributors to this study include both cardiologists and endocrinologists: DCRI fellow Anthony Carnicelli, MD; along with DCRI faculty Renato Lopes, MD, PhD; Jennifer Green, MD; Emily O’Brien, PhD; Neha Pagidipati, MD, MPH; and Christopher Granger, MD.

First Published in DCRI News