IDF21-0553 The Beneficial Impact of Interdisciplinary Collaboration on the Prescription of Cardioprotective Antidiabetic Drugs

Abstract

Background: Glucagon-like peptide-1 receptor agonists (GLP-1 RA) and sodium-glucose co-transporter-2 inhibitors (SGLT2i) have proven their pleiotropic effects such as beneficial outcomes on morbidity and even mortality in several recent large trials. These findings have led to updated guidelines that recommend these agents early in the management of patients with type 2 diabetes mellitus (T2DM), particularly if other conditions such as atherosclerotic cardiovascular disease (ASCVD), heart failure (HF), chronic kidney disease (CKD) or indicators of high risk are present. However, real-life evidence has shown that the prescription of these classes of antidiabetic drugs remains low. Aim: The aims of our study were to investigate the implementation of recent guidelines regarding the management of T2DM in patients with ASCVD admitted to a cardiology unit from the Western part of Romania and the impact a novel interdisciplinary collaboration between the diabetology and cardiology departments on the prescription of antihyperglycemic agents with proven cardioprotective effects. Method: In this cross-sectional, non-interventional study, we enrolled 73 patients previously diagnosed with T2DM and ASCVD that have been referred to the Diabetes Compartment of the Emergency Hospital Timisoara from Institutul de Boli Cardiovasculare Timisoara (IBCV) between November 2019 and July 2021 in the context of the previously mentioned collaboration. Data regarding the patients’ age, body mass index (BMI), HbA1c, estimated glomerular filtration rate (eGFR), left ventricular ejection fraction (LVEF) and the antihyperglycemic agents prescribed by physicians from other medical centres based in different geographical areas of Romania before the admittance to IBCV were collected from the patients’ medical records. Furthermore, new recommendations of treatment have been proposed after taking into consideration individualised treatment goals and strategies and these were added to the hospital discharge documents. Results: Out of the total number of 73 patients with T2DM and ASCVD, only 5.4% (n=4) had an antihyperglycemic regimen containing a GLP-1 RA before their admission to IBCV and, similarly, only 5.4% (n=4) had an SGLT2i among their drugs. The most frequently found antihyperglycemic agent was, as expected, metformin – 65.7% (n=48), followed by sulphonylureas at 32.8% (n=24), insulin – 23.2% (n=17), DPP4i – 12.3% (n=9), diet as the only intervention – 10.9% (n=8) and acarbose – 1.3% (n=1). Discussion: However, the recommendations that were made during the hospitalization as a part of our program have increased the proportion of patients treated with GLP-1 RA to 21.9% (n=16) and with SGLT2i to 26.0% (n=19), leading to an increase of the prescription of cardioprotective agents from 10.8% to 47.9%. In conclusion, the implementation of recent guidelines regarding the treatment of patients with T2DM and ASCVD could be further improved in real-life practice through a collaboration between diabetology and cardiology departments with beneficial results in the recommendation of antihyperglycemic agents with proven cardiovascular benefits.