Remote medication program increases GDMT prescriptions in T2D patients with high CV or kidney risk
ACC.24 - A remote program comprising simultaneous patient education and medication management increased SGLT2i and GLP-1RA prescriptions at 6 months in T2D patients at elevated CV and/or renal risk compared with an approach providing education first followed by medication management.
This summary is based on the presentation of Alexander Blood, MD (Boston, MA, USA) at the ACC.24 Scientific Session - The Diabetes Remote Intervention To Improve Use Of Evidence-based Medications (drive) Study: A Randomized Evaluation Of A Team-based Remote Education And Medication Management Program To Reduce Cv And Kidney Risk.
Introduction and methods
Several SGLT2 inhibitors and GLP-1RAs can reduce the risk of CV events and improve renal outcomes in T2D patients who are at elevated CV and/or renal risk. Despite guideline recommendations and programs aimed at increasing their use, the utilization of these drugs, however, remains low. Various strategies have been tried to overcome the known patient, provider, payer, and system-level barriers, with varying degrees of success.
The DRIVE (Diabetes Remote Intervention to improVe use of Evidence-based medications) study was a randomized trial conducted through the Mass General Brigham network in Boston, MA, USA in which a remote medication management program designed to initiate and titrate guideline-directed medical therapy (GDMT) was evaluated. In total, 200 T2D patients with ASCVD, HF, CKD, or high ASCVD risk who were eligible for, but not prescribed, an SGLT2 inhibitor or GLP-1 RA were randomized to either simultaneous virtual patient education and SGLT2 inhibitor or GLP-1RA prescription for 6 months (“simultaneous”) or virtual education for 2 months followed by medication prescription for 4 months (“education-first”). A multidisciplinary team provided the education and prescribed the medications using a standardized treatment algorithm.
The primary endpoint was the proportion of patients with SGLT2 inhibitor or GLP-1 RA prescriptions at 6 months. Secondary endpoints were the number of SGLT2 inhibitor or GLP-1RA prescriptions by treatment arm, change in HbA1c level, change in body weight, and Patient Activation Measaure.
Main results
- After 6 months, the cumulative frequency of SGLT2 inhibitor or GLP-1RA prescriptions was 69.8% among patients in the simultaneous group (n=116) and 56.0% in patients in the education-first group (n=84) (P<0.001).
- The cumulative proportion of patients who reported having taken an SGLT2 inhibitor or GLP-1RA at 6 months was 59.5% in the simultaneous group and 44.0% in the education-first group (P<0.001).
- The median time from randomization to first prescription was lower in the simultaneous group (24 days; IQR: 13–50) than in the education-first group (85 days; IQR: 65–106; P<0.0001), as was the median time from randomization to taking the medication (25 days; IQR: 18–42 vs. 99 days; IQR: 16–121; P<0.001).
- There were no significant differences in the change in HbA1c or body weight at 6 months (both P>0.05).
Conclusion
The use of a remote, multidisciplinary team–based program comprising simultaneous patient education and medication management in the US increased the prescription and intake of SGLT2 inhibitors and GLP-1RAs at 6 months in T2D patients at elevated CV and/or renal risk compared with an approach providing education first followed by medication management.
- Our reporting is based on the information provided at the ACC.24 Scientific Session -