Remote care drove medication uptake among type 2 diabetes patients

April 10, 2024 - New research reveals that a remote care team focused on patient education and medication management can improve guideline-directed medical therapy (GDMT) adherence in patients with type 2 diabetes who are at high risk of adverse cardiovascular events and/or kidney outcomes.

Conducted by researchers from Mass General Brigham, the study assessed a remote care approach to increasing the use of medications that enhance cardiovascular and kidney outcomes among type 2 diabetes patients.

The disease is widespread in America, where about 36 million people had type 2 diabetes in 2021. Comorbidities are also common in this population. According to the American Diabetes Association, cardiovascular disease is the No. 1 cause of death in people living with diabetes, and diabetes is the leading cause of chronic kidney disease.

While several sodium-glucose transport protein 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1 RA) have been shown to improve cardiovascular and kidney outcomes, uptake of these medications is low among type 2 diabetes patients.

Thus, Mass General Brigham researchers investigated whether a remote care approach could boost guideline-directed medication use in the type 2 diabetes population. The study results were presented at the 2024 American College of Cardiology’s Annual Scientific Session and published in the journal Circulation.

The study included 200 adult patients with type 2 diabetes who were at elevated risk of cardiac and/or kidney complications. Their mean age was 66.5 years; 36.5 percent were female, and 22 percent were not White.

The patients were divided into two groups: one received virtual patient education concurrently with prescriptions of SGLT2i or GLP-1 RA, while the other received two months of dedicated virtual education followed by medication prescriptions. The researchers called the first group the “simultaneous” group and the second the “education-first” group. The groups received patient education and treatment from a multidisciplinary group of patient navigators, pharmacists, nurse practitioners, and physicians.

Overall, 30 percent of the study population had cardiovascular disease, 5 percent had cerebrovascular disease, and 1.5 percent had both. The mean estimated glomerular filtration rate (eGFR) of the study population was 77.9 mL/min/1.73m2, and the mean urine/albumin creatinine ratio (UACR) was 88.6mg/g.

After two months, 34.5 percent of patients overall received a new prescription for either SGLT2i or GLP-1 RA. Of these, 53.4 percent were in the “simultaneous” group, and 8.3 percent were in the “education-first” arm.

At the six-month mark, 64 percent received a new prescription. Nearly 70 percent of these patients were in the “simultaneous” group versus 56 percent in the “education-first” group. Further, almost 60 percent of patients in the “simultaneous” group self-reported taking SGLT2i or GLP-1 RA within six months of beginning the trial, compared to 44 percent of patients in the “education-first” group.

“Our results suggest that patients are more inclined to adhere to therapy when approached with education and treatment simultaneously and immediately,” said corresponding author Alexander J. Blood, MD, an attending cardiovascular medicine physician at Brigham and Women’s Hospital, in a press release. “Providers should ‘strike while the iron is hot.’ If a patient is already interested in investing in their health and willing to meet with you, that’s the time to initiate treatment while providing educational resources.” Brigham and Women’s Hospital is a founding member of the Mass General Brigham healthcare system.

The study bolsters previous research, showing that remote care approaches can improve type 2 diabetes outcomes.

In fact, a remote care program managed by pharmacists at St. Joseph’s/Candler (SJ/C) health system in Savannah, Georgia, helped boost outcomes for patients with type 2 diabetes, according to a study published in 2021.

Researchers examined 30 patients who received type 2 diabetes care between August 2019 and February 2020 before the pandemic and 61 patients who received care between March and October 2020, when the program had launched.

At six months, the patients in the pre-pandemic group saw an average A1C reduction of 1.2 percent, while the pandemic group experienced a 2.2 percent decrease in A1C levels.