Cardiologist Education Key to Adoption of Advanced T2D Drugs

CV Disease treatment results in 3x to 5x more Cardio than Endo visits per year but prescriptions by Cardiologists are low for advanced glucose-lowering agents despite CV benefits

Martin HenselApril 16, 2019

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Felona Gunawan, MD and Clinical Fellow at Yale Endocrinology & Metabolism Fellowship Training Program

We corresponded with Felona Gunawan, MD (bio) from the endocrinology department at the Yale School of Medicine and Yale-New Haven Hospital about her presentation at the Endocrine Society.

Background

“Diabetes is a growing problem worldwide and cardiovascular disease is a leading cause of mortality among patients with T2D. Recent large CV outcome trials demonstrated significant CV benefits of two novel classes of glucose-lowering agents (GLAs), specifically SGLT2 inhibitors and GLP-1 receptor agonists.

“Adults with type 2 diabetes and cardiovascular disease are much more likely to encounter cardiologists than endocrinologists in the outpatient setting – they are about 5x more likely to visit a cardiologist than an endocrinologist.”

“Treatment guidelines now recommend that these medications should be favored in patients with T2D and overt CVD. Not surprisingly, endocrinologists prescribe these medications more frequently than cardiologists.

“It has been proposed that cardiologists should take a more active role in prescribing these GLAs for CV risk reduction.

We compared prescribing opportunities for these GLAs, by assessing the likelihood that a patient with T2D and CVD had an outpatient encounter with a cardiologist vs. an endocrinologist over one year period.”

Methods

“We reviewed electronic health records of adult patients with T2D who had outpatient encounters within the Yale-New Haven Hospital System in 2017.

“We analyzed demographic information, CVD diagnostic categories (coronary artery disease, heart failure, cerebrovascular disease, peripheral vascular disease), the number of cardiology and endocrinology encounters, and visit diagnoses.”

Results

About 40% of patients with T2DM had co-existing cardiovascular disease. The ratio of cardiologist-to-endocrinologist outpatient encounters was 2.6 for all T2D patients. The likelihood was even higher (greater than 5 fold) for patients with coexisting CVD. Of the 4 CVD diagnoses, patients with heart failure had the highest cardiologist to endocrinologist encounter ratio at 8.4.

Conclusion

“In order to capitalize on the CV benefits of the newer GLAs, prescriptions by cardiologists are likely to hasten adherence to the latest guidelines and improve patient outcomes.

“Educational programs pertaining to these emerging treatment paradigms should target cardiologists in addition to endocrinologists (and primary care physicians).”