1046-P: ELEGANT-DM2—Early Intervention Addressing Therapeutic Inertia in Diabetes Mellitus-2

Abstract

Primary care (PC) models for DM2 care driven by clinical pharmacists (CPs) have shown benefits, while access to a diabetologist (DCS) for patients with complex DM2 is limited. A prospective observational study at VA Pittsburgh Healthcare System studied the impact of a novel collaborative care model: ELEGANT-DM2 used a diabetes dashboard (DD) to identify patients with clinical therapy inertia (CTI) and weekly virtual huddles linking CPs in PC with a DCS for case review and recommendations. Using a DD, 103 patients with DM2 and A1c>9% were enrolled between 09/2020 to 03/2021 and received the collaborative care intervention over 12 months. Patient demographics, comorbidities, A1c at 12-months (PRE-12) pre-enrollment, enrollment (E), and 12 months (PS-12) post-enrollment, and diabetes medications at E and PS-12 were extracted. A non-parametric test was used to compare continuous outcome measures (Mean+/-SD); categorical measures as percentages. McNemar test was used to conduct pre-post proportion comparisons in specific cohorts for SGLT-2i and GLP-1RA medications. The study cohort was mostly male (94%), white (90%), with a mean age of 69.3 years, had pre-existing CVD (91%), obesity (89%), HTN (87%), CKD (16%), and CHF (10%). A significant rise in A1c was noted from 9.3% (+/-1.4) at Pre-12 to 10.8% (+/-1.5) at E (p=.008). A significant decline was noted in A1c from 10.8% (+/- 1.5) at E to 8.2% at PS-12 (p=<0.001). In patients with DM2 and CVD, use of SGLT-2i and GLP-1RA increased significantly (SGLT-2i: 16.5% at E to 29% at PS-12, p=0.009; GLP-1A: 20% at E to 36% at PS-12, p=.003). In patients with DM2 and obesity, GLP-1RA use increased from 18.2 % at E to 39.4% at PS-12 (p=.0008). A non-significant increase in the use of SGLT-2i was seen in cohorts with CKD and CHF. ELEGANT-DM2 identified CTI using DD, eliminated the traditional referral process, led to therapy optimization via virtual huddles between PC CPs and DCS, and delivered sustained improvement in DM2 control and uptake of new medications Disclosure A.Bandi: None. D.Becker: None. S.Sodders: None. M.Zupa: None. J.L.Mccoy: None. N.M.Pertinaci: None. M.Y.Boudreaux-kelly: None. Funding Office of Health Equity (SPRV-OHEA160)