A team-based approach to type 2 diabetes and cardiovascular care

The Center for Integrated and Novel Approaches in Vascular-Metabolic Disease (CINEMA) program is an innovative, patient-centered system of care developed by the University Hospitals Harrington Heart and Vascular Institute in Cleveland, Ohio in the US for the management of high-risk patients with type 2 diabetes (T2D) and prediabetes at high risk for cardiovascular-kidney-metabolic (CKM) syndrome and its consequences. At its core, CINEMA is a multidisciplinary team of care experts, working together outside of traditional silos. The patient meets with the entire team up to 4 times each year to address all aspects of cardiovascular (CV) and T2D care. At the first visit, the team formulates a personalized approach that is evidence based and centered on optimal strategies to improve the patient's lifestyle, reduce their risk of CV and kidney disease events, and increase their access and adherence to guideline-directed pharmacologic therapies. A community health worker is utilized to address social determinants of health as needed. The program has a substantial research component, with the intent of developing evidence for novel care paradigms. The multiyear results of the CINEMA program indicate that a multidisciplinary approach to management of high-risk patients is highly effective in reducing CKM syndrome risk factors and increases use of guideline-directed therapies. The aim of this review is to describe the structure, operation, and eligibility criteria for admission to the CINEMA program, provide an overview of how CKM syndrome risks are determined and managed for each patient, and discuss how the integrated approach to care is supported by current recommendations from professional societies and results from other coordinated care/multidisciplinary programs. Lastly, the scalability challenges of a wider rollout of the CINEMA program are considered.