T2DM patients more likely see cardiologist than endocrinologist in outpatient setting
Relative frequency of cardiology vs. endocrinology visits by type 2 diabetes patients with cardiovascular disease in the USA: implications for implementing evidence-based use of glucose-lowering medications
Literature - Gunawana F, Nassifb ME, Partri C, et al. - Cardiovasc Endocrinol Metab. 2020, 9: 56–59, DOI: 10.1097/XCE.0000000000000195Introduction and methods
Guidelines from the ADA and ACC recommend use of SGLT2i and GLP-1RA in T2DM patients with coexisting CVD [1,2]. However, to date limited use of these medication classes has been observed in this patient population [3]. Examining prescription patterns of these drugs may give insights for the slow incorporation of the guidelines recommendations in the USA. Endocrinologists prescribe these drugs more frequently than cardiologists and primary care providers (PCPs) [4]. But on a nationwide level, there are more cardiologists and PCPs than endocrinologists [5]. The question was raised whether greater involvement of these specialties is needed. Also, because cardiologists have frequent encounters with T2DM patients, there have been calls for a more active role of cardiologists in prescribing SGLT2i and GLP-1RA for CV risk reduction in T2DM.
This study examined the likelihood that a T2DM patients with CVD had outpatient encounters with a cardiologist vs. an endocrinologist over a one-year period in 2 large healthcare systems in the USA.
A retrospective review of electronic health records of T2DM patients with outpatient encounters within two large USA healthcare systems (one in New England and one in the Midwest) during 2017 was conducted. Initial consult, follow-up, appointment, office visit, evaluation were included as outpatient encounter types, and all procedural visits were excluded. 109.747 T2DM patients were included of whom 42.6% had CVD.
Main results
- Ratio of cardiology-to-endocrinology outpatient encounters was 2.0:1 for all patients.
- For T2DM patients with CVD, ratio of cardiology-to-endocrinology was 4.1:1.
- For T2DM patients with CVD, ratio of PCP-tot-endocrinology outpatient encounters was 4.0:1.
- T2DM patients with heart failure had the highest cardiology-to-endocrinology encounter ratio at 6.8:1.
Conclusion
In a retrospective study of American patients, a patient with T2DM with CVD was four times more likely to see a cardiologist that an endocrinologist in an outpatient setting. This increased frequency of encounters by cardiologists is a great opportunity to discuss glucose-lowering medication with CV benefits and highlights the emerging potential to implement evidence-based glucose-lowering therapies. Establishing a new subspeciality of cardiometabolic medicine may contribute to optimizing regimens with CV benefit in patients with T2DM and CVD.
References
1. American Diabetes Association. 9. Pharmacologic approaches to glycemic treatment: Standards of Medical Care in Diabetes – 2019. Diabetes Care 2019; 42 (Suppl. 1):S90–S102.
2. Das SR, Everett BM, Birtcher KK, Brown JM, Cefalu WT, Januzzi JL Jr, et al. 2018 ACC expert consensus decision pathway on novel therapies for cardiovascular risk reduction in patients with type 2 diabetes and atherosclerotic cardiovascular disease: a report of the american college of cardiology task force on expert consensus decision pathways. J Am Coll Cardiol 2018; 72:3200–3223.
3. Arnold SV, Inzucchi SE, Tang F, McGuire DK, Mehta SN, Maddox TM, et al. Real-world use and modeled impact of glucose-lowering therapies evaluated in recent cardiovascular outcomes trials: an NCDR® research to practice project. Eur J Prev Cardiol 2017; 24:1637–1645.
4. Vaduganathan M, Sathiyakumar V, Singh A, McCarthy CP, Qamar A, Januzzi JL Jr, et al. Prescriber patterns of SGLT2I after expansions of U.S. Food and drug administration labeling. J Am Coll Cardiol 2018; 72:3370–3372.
5. Association of American Medical Colleges. active physicians in the largest specialties. 2017. https://www.aamc.org/data/workforce/reports/492556/1- 1-chart.html. [Accessed 13 July 2019].
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