Researchers Devised a Multifaceted Intervention to Enhance Heart Disease and Type 2 Diabetes Care

A patient’s cooperation is vital to ensure the effectiveness of the medication and therapies prescribed to them. It’s also important that they are given the best set of guidance to further improve their health condition. Heart diseases and diabetes are two of those illnesses that require efficient medication. Otherwise, the disease may severely develop and might cause premature death. Researchers are continuously finding and devising treatments to improve preventive care. And recently, a study about coordinated, multifaceted intervention for heart diseases and diabetes has shown impressive results. The process is said to enhance prescribing practices in medical professionals.

Led by Neha J. Pagidipati, MD, MPH, associate professor of medicine in cardiology at Duke University School of Medicine and Duke Clinical Research Institute, the research was presented at the American College of Cardiology’s Annual Scientific Session Together With the World Congress of Cardiology. Their findings were published in the Journal of the American Medical Association. The study explained how patients with type 2 diabetes and heart disease will be advised to have three classes of guidelines for preventive medications. It was also mentioned that only a few patients receive prescriptions that indicate every medication and therapy that could improve their condition.

The team proved the efficacy of the coordinated, multifaceted intervention through a randomized trial. Forty-three cardiology clinics were assigned with basic education or a six-part tailored intervention devised to enhance prescriptions. The medications include:

• Statins to reduce cholesterol levels.
• Angiotensin converting enzyme inhibitors (ACEi/ARBs), to regulate blood pressure and protect the heart and the kidneys.
• Sodium-glucose cotransporter-2 inhibitors (SGLT2i) or glucagon-like peptide-1 receptor agonists (GLP-1Ras), to provide cardiovascular and kidney benefits.

Devising the coordinated, multifaceted intervention was aided by a cardiologist, an endocrinologist, and a nurse. The team exchanged information with the randomly assigned clinics to analyze barriers in prescribing therapies, create solutions for those barriers, and supply audits and feedback. During the process, there were 1,049 adults around their 70s, and 32.2% were women. Participants were type 2 diabetes and atherosclerotic cardiovascular disease patients who did not receive all three medication classes from 2019 to 2022.

The last follow-up was 12 months after the initial intervention, and 38% of patients were taken under the complete tailored intervention and were prescribed the three classes of medication. There was a significant difference from the 14.5% of patients that received the usual routine care in clinics and were advised with all three medicines. The difference in results ranged from an increase in SGLT2i and GLP-1RA drug prescriptions. It increased in both groups but was higher in clinics with the tailored intervention. Professor Pagidipati also clarified that the patients consumed the medications in similar intakes based on the prescription.

Utilizing multiple components was the key to the successful intervention trial. The collaborative work will produce accessible information, so it can be applied through healthcare establishments. With the trial’s results, the guideline-recommended preventive care may also aid patients in better handling their chronic health conditions. Although the results were impressive, Pagidipati and her team still needed to distinguish clinics and patients that benefited from the intervention. “Because if it worked at all of the clinics equally, we probably would have seen an even higher benefit. And so it is still on us to understand what are the characteristics of the clinics and the patients that would benefit more from this,” she added.

The professor also explained in TCTMD, “Evidence-based therapies are underused in clinical practice, and that is not just limited to patients with diabetes, and it is not just limited to these therapies, and yet there is little high-quality data on how we can improve this. We now have randomized data that this multifaceted intervention is effective in increasing the prescription of evidence-based therapies in adults with type 2 diabetes and atherosclerotic cardiovascular disease. Even though it was multifaceted, it was low tech, [and] it was delivered in the midst of a pandemic. It was designed to be scalable.”

Barriers that still need to be dealt with are prior authorizations, availability of medications, familiarity with the drugs, and clinical settings. Further investigation will be conducted by the team to continuously analyze data and address challenges in imploring the coordinated, multifaceted intervention. Also, the professor shared that the tools they used for the trial were not high-tech and accessible online for free.