Randomized Evaluation of a Remote Management Program to Improve Guideline-Directed Medical Therapy: The DRIVE Trial

Area of Science:

• Endocrinology and Metabolism
• Cardiovascular Medicine
• Nephrology

Background:

• Sodium-glucose transport protein 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP1-RA) are recommended for type 2 diabetes (T2D) patients to reduce cardiovascular and kidney events.
• Despite proven benefits, the utilization of SGLT2i and GLP1-RA in eligible T2D patients remains suboptimal.
• Addressing this gap requires innovative strategies to improve guideline-directed medical therapy (GDMT) in T2D management.

Purpose of the Study:

• To evaluate the effectiveness of a remote, team-based implementation strategy for increasing SGLT2i and GLP1-RA prescriptions in T2D patients at high cardiovascular or kidney risk.
• To compare the efficacy of a simultaneous virtual patient education and medication prescription approach versus an education-first model.
• To assess the impact of this program on guideline-directed medical therapy optimization in a real-world clinical setting.

Main Methods:

• A randomized, remote implementation trial was conducted within the Mass General Brigham network, enrolling T2D patients eligible for but not prescribed SGLT2i or GLP1-RA.
• Participants were randomized to either a 'Simultaneous' arm (virtual education concurrent with prescription) or an 'Education-First' arm (2 months of education prior to prescription).
• A multidisciplinary team, including nonlicensed navigators and clinical pharmacists, utilized a standardized algorithm for prescribing SGLT2i or GLP1-RA. The primary outcome was the proportion of patients with prescriptions by 6 months.

Main Results:

• The 'Simultaneous' approach led to significantly higher prescription rates of SGLT2i or GLP1-RA compared to the 'Education-First' approach at both 2 months (53.4% vs. 8.3%) and 6 months (69.8% vs. 56.0%).
• Overall, 64.0% of all randomized patients received a new prescription within 6 months, with a median time to first prescription of 24 days in the 'Simultaneous' arm versus 85 days in the 'Education-First' arm.
• Patient self-report of medication use also favored the 'Simultaneous' arm (59.5% vs. 44.0%), indicating improved adherence and treatment initiation.

Conclusions:

• A remote, team-based program effectively identifies high-risk T2D patients and facilitates the prescription of SGLT2i and GLP1-RA, thereby improving GDMT.
• The simultaneous delivery of virtual education and medication prescription is a more effective strategy than an education-first approach for increasing uptake of these vital medications.
• These findings support the broader adoption of virtual, team-based care models to enhance chronic disease management and optimize treatment outcomes in T2D.