Proposed Person-Specific Treatment Pathway for Cardiovascular Metabolic Renal Disease & Implications to Population Health

Abstract

The WHO considered Diabetes a global epidemic in its first Global Report on Diabetes published in 2016.1 Diabetic treatment standards of care have shifted immensely in the previous decade with the emergence of new therapeutic classes and important evidence from Cardiovascular and Renal Outcomes Trials (CVOT). These studies have helped to draw connections that newer therapies are not simply reducing hyperglycemia but lessen risk of atherosclerotic events, heart failure and worsening renal function. Through this meaningful research, there is a growing body of evidence to begin approaching the treatment of diabetes as a cardiovascular-metabolic-renal disease. There is much work to be completed in this area as there is a notable content gap that directly tackles both the complexities of disease and comprehensive therapeutic treatment implementation in diabetes patients. Data overload and rapid changes to standards of care have left providers, payers, and PBM’s with unclear direction forward. This paper works to highlight the importance of the previous decade of research including the CVOT outcomes, illustrates an optimized person-specific pathway for therapeutic treatment of the cardiovascular metabolic renal disease patient and assesses the implications to population health including care delivery and total cost of care. Our proposed pathway joins guideline-based treatment and CVOT data to provide a practical application to implement in incremental patient care. Finally, provides a real-world framework implementation plan of a multi-interdisciplinary team for a value-based outcome driven initiative.