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COORDINATE evaluates prescription therapy for patients with type 2 diabetes and ASCVD


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A coordinated model designed to overcome patient-, clinic-, and system-level barriers to care can dramatically boost prescribing of evidence-based drug therapies for individuals with both type 2 diabetes and atherosclerotic disease (ASCVD). The COORDINATE-Diabetes trial found a significant improvement in prescribing all three groups of preventative medications recommended for these patients—high-intensity statins, angiotensin converting enzymes (ACEIs) or angiotensin II receptor blockers (ARBS), and sodium-glucose-cotransporter 2 (SGLT2) inhibitors and/or glucagon-like peptide-1 receptor agonists (GLP-1 receptor agonists)—compared to usual care.

Trial investigators, including principal investigator Chris Granger, MD, FACC, FAHA, Professor of Medicine and in the School of Nursing at Duke University School of Medicine and a member of Duke Clinical Research Institute, will discuss the clinical impact of identifying and reducing barriers to care during the COORDINATE—Diabetes Study Results Symposium on Monday, June 26, from 1:30 – 3:00 p.m. PT in Room 30. This session also will be available via livestream for registered meeting participants.

Neha Pagidipati, MD, MPH
Neha Pagidipati, MD, MPH

The investigators will focus on the successful intervention, a clinic-specific analysis of barriers to care for patients and clinicians, and a strategic care pathway designed to eliminate or moderate barriers to care at each clinic in the study.

“There is a huge gap between what we know we should be doing for patients and what patients are actually receiving in clinical settings,” said Neha Pagidipati, MD, MPH, Associate Professor of Medicine at Duke University School of Medicine. “What COORDINATE has shown us is that despite many barriers to getting good quality care, this intervention is able to overcome at least some of them such that a significant proportion of the population gets better care with this intervention than they would with usual care.”

Patient-level barriers were largely familiar, she noted. Common problems included lack of transportation to the clinic and/or to pharmacies to fill prescriptions, time constraints due to work or other unavoidable conflicts, lack of nearby pharmacies, and cost of treatment.

Some system- and clinic-level barriers were less familiar. Clinic surveys found that SGLT2 inhibitors and GLP-1 receptor agonists were unfamiliar territory for some clinicians.

“For clinics that had access to a pharmacist or a pharmacist technician, it was extremely important to engage them early on because they could help patients access some of these medications, especially the SGLT2 inhibitors and GLP-1 receptor agonists,” Dr. Pagidipati said. “Pharmacy is familiar with the processes to file for prior authorizations and other steps to ensure that patients were actually getting access to these medications while streamlining the process for clinicians. Coordination of care between professionals within the clinical setting was a key part of the intervention success.”

COORDINATE-Diabetes enrolled patients with both type 2 diabetes and ASCVD in a cluster randomized trial at 20 intervention clinics (459 patients) and 23 usual care clinics (590 patients). The primary outcome was the proportion of individuals taking all three classes of recommended medications on the last follow-up visit six or 12 months after enrollment.

At the last follow-up visit, those in the intervention arm were more likely to be prescribed all three recommended classes versus the standard care arm. The symposium will provide in-depth analysis and perspective of these results.

“As important as it is to develop new therapies, it is at least as important, if not more important, to focus on actually getting therapies to the patients who need them,” Dr. Pagidipati said. “This study proves that the prescribing of these medications can be substantially improved, and we know that increasing the use of these medications will prevent future cardiovascular events.”