Opportunities for improving use of evidence-based therapy in patients with type 2 diabetes and cardiovascular disease

Area of Science:

• Cardiology
• Endocrinology
• Health Services Research

Background:

• Cardiovascular risk reduction therapies (e.g., for hyperlipidemia, hypertension, smoking cessation, weight loss) significantly benefit patients.
• While intensive glucose lowering's benefit is unclear, newer antidiabetic drugs show cardiovascular advantages.
• Management of cardiovascular risk in type 2 diabetes (T2D) and cardiovascular disease (CVD) patients is often suboptimal.

Purpose of the Study:

• Identify barriers to translating evidence-based cardiovascular risk reduction therapies into clinical practice for T2D and CVD patients.
• Synthesize implementation strategies to improve care for this population.

Main Methods:

• Narrative review identifying barriers at provider, health system, patient, and cost levels.
• Synthesis of previous implementation strategies targeting these barriers.

Main Results:

• Barriers to evidence translation include provider, system, patient, and cost factors.
• Effective strategies include team-based care coordination, reminder systems, pharmacist consultation, patient education, provider education, and coupled provider-patient incentives.
• These strategies showed effectiveness in reducing cardiovascular risks for T2D and CVD patients.

Conclusions:

• Team-based care, patient education, and provider education are effective in reducing cardiovascular risks for T2D and CVD patients.
• The scalability and long-term clinical impact of these strategies require further investigation.
• The role of payers and health systems in interventions remains uncertain.