Abstract
Background: The care model for type 2 diabetes (T2D) and its main complications is thought to be “asynchronous” and associated with delays in care and low use of guideline-directed medical therapies (GDMT). Hypothesis: A synchronous care clinic for T2D patients, including a simultaneous evaluation by cardiology/endocrinology and nephrology, will enhance the rate of GDMT use and improve biomarkers of interest. Methods: Retrospectively analysis from patients evaluated in the DECIDE-CV clinic, a cardiometabolic clinic for T2D patients with either atherosclerotic cardiovascular disease, heart fialure (HF) or chronic kidney disease (CKD). Baseline data was compared to the data obtained in the last available visit. For patients with only one visit, the treatment prescribed at the end of the first visit was considered in the last visit group. Categorical data is presented as frequencies (proportions) and was analyzed using McNemar test. Continuous data is presented as mean±SD or median (IQR) as appropriate and was compared using the t-test for paired data or Wilcoxon test. Results: 150 patients, 72% male with a mean age of 67±12 years. 115 (78%) had atherosclerotic cardiovascular disease, 98 (65%) had HF and 77 (51%) CKD. Comparing baseline to last visit data, there was a statistically significant increase in GDMT and de-escalation of insulin, sulfonylureas and DPP4i (Table). For patients with two sets of available laboratory data, there was a significant decrease in N-terminal pro B-type natriuretic peptide (504 [155-1160] pg/mL vs 335 [150-1031] pg/mL, p=0.03) and albuminuria (57 [19-259] mg/g vs 57 [9-155] mg/g, p<0.01). Conclusion: A synchronous care clinic for T2D patients is associated with increased use of GDMT, de-escalation of therapy that lack morbidity/mortality benefit, and improvement in prognostic biomarkers. These results can potentially translate into better outcomes in this population.
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