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Randomized Evaluation of a Remote Management Program to Improve Guideline-Directed Medical Therapy: The DRIVE Trial.
Blood, Alexander J; Chang, Lee-Shing; Hassan, Shahzad; Chasse, Jacqueline; Stern, Gretchen; Gabovitch, Daniel; Zelle, David; Colling, Caitlin; Aronson, Samuel J; Figueroa, Christian; Collins, Emma; Ruggiero, Ryan; Zacherle, Emily; Noone, Joshua; Robar, Carey; Plutzky, Jorge; Gaziano, Thomas A; Cannon, Christopher P; Wexler, Deborah J; Scirica, Benjamin M.
Affiliation
  • Blood AJ; Accelerator for Clinical Transformation (A.J.B., S.H., J.C., G.S., D.G., D.Z., S.J.A., C.F., E.C., R.R., J.P., T.A.G., C.P.C., B.M.S.), Brigham and Women's Hospital, Boston, MA.
  • Chang LS; Divisions of Cardiovascular Medicine (A.J.B., S.H., J.C., J.P., T.A.G., C.P.C., B.M.S.), Brigham and Women's Hospital, Boston, MA.
  • Hassan S; Harvard Medical School, Boston, MA (A.J.B., L-S.C., C.C., J.P., T.A.G., C.P.C., D.J.W., B.M.S.).
  • Chasse J; Endocrinology, Diabetes, and Hypertension (L-S.C.), Brigham and Women's Hospital, Boston, MA.
  • Stern G; Harvard Medical School, Boston, MA (A.J.B., L-S.C., C.C., J.P., T.A.G., C.P.C., D.J.W., B.M.S.).
  • Gabovitch D; Accelerator for Clinical Transformation (A.J.B., S.H., J.C., G.S., D.G., D.Z., S.J.A., C.F., E.C., R.R., J.P., T.A.G., C.P.C., B.M.S.), Brigham and Women's Hospital, Boston, MA.
  • Zelle D; Divisions of Cardiovascular Medicine (A.J.B., S.H., J.C., J.P., T.A.G., C.P.C., B.M.S.), Brigham and Women's Hospital, Boston, MA.
  • Colling C; Accelerator for Clinical Transformation (A.J.B., S.H., J.C., G.S., D.G., D.Z., S.J.A., C.F., E.C., R.R., J.P., T.A.G., C.P.C., B.M.S.), Brigham and Women's Hospital, Boston, MA.
  • Aronson SJ; Divisions of Cardiovascular Medicine (A.J.B., S.H., J.C., J.P., T.A.G., C.P.C., B.M.S.), Brigham and Women's Hospital, Boston, MA.
  • Figueroa C; Accelerator for Clinical Transformation (A.J.B., S.H., J.C., G.S., D.G., D.Z., S.J.A., C.F., E.C., R.R., J.P., T.A.G., C.P.C., B.M.S.), Brigham and Women's Hospital, Boston, MA.
  • Collins E; Accelerator for Clinical Transformation (A.J.B., S.H., J.C., G.S., D.G., D.Z., S.J.A., C.F., E.C., R.R., J.P., T.A.G., C.P.C., B.M.S.), Brigham and Women's Hospital, Boston, MA.
  • Ruggiero R; Accelerator for Clinical Transformation (A.J.B., S.H., J.C., G.S., D.G., D.Z., S.J.A., C.F., E.C., R.R., J.P., T.A.G., C.P.C., B.M.S.), Brigham and Women's Hospital, Boston, MA.
  • Zacherle E; Harvard Medical School, Boston, MA (A.J.B., L-S.C., C.C., J.P., T.A.G., C.P.C., D.J.W., B.M.S.).
  • Noone J; Accelerator for Clinical Transformation (A.J.B., S.H., J.C., G.S., D.G., D.Z., S.J.A., C.F., E.C., R.R., J.P., T.A.G., C.P.C., B.M.S.), Brigham and Women's Hospital, Boston, MA.
  • Robar C; Personalized Medicine, Mass General Brigham, Cambridge (S.J.A.).
  • Plutzky J; Accelerator for Clinical Transformation (A.J.B., S.H., J.C., G.S., D.G., D.Z., S.J.A., C.F., E.C., R.R., J.P., T.A.G., C.P.C., B.M.S.), Brigham and Women's Hospital, Boston, MA.
  • Gaziano TA; Accelerator for Clinical Transformation (A.J.B., S.H., J.C., G.S., D.G., D.Z., S.J.A., C.F., E.C., R.R., J.P., T.A.G., C.P.C., B.M.S.), Brigham and Women's Hospital, Boston, MA.
  • Cannon CP; Accelerator for Clinical Transformation (A.J.B., S.H., J.C., G.S., D.G., D.Z., S.J.A., C.F., E.C., R.R., J.P., T.A.G., C.P.C., B.M.S.), Brigham and Women's Hospital, Boston, MA.
  • Wexler DJ; Novo Nordisk, Inc., Plainsboro, NJ (E.Z., J.N., C.R.).
  • Scirica BM; Novo Nordisk, Inc., Plainsboro, NJ (E.Z., J.N., C.R.).
Circulation ; 149(23): 1802-1811, 2024 Jun 04.
Article in En | MEDLINE | ID: mdl-38583146
ABSTRACT

BACKGROUND:

Several SGLT2i (sodium-glucose transport protein 2 inhibitors) and GLP1-RA (glucagon-like peptide-1 receptor agonists) reduce cardiovascular events and improve kidney outcomes in patients with type 2 diabetes; however, utilization remains low despite guideline recommendations.

METHODS:

A randomized, remote implementation trial in the Mass General Brigham network enrolled patients with type 2 diabetes with increased cardiovascular or kidney risk. Patients eligible for, but not prescribed, SGLT2i or GLP1-RA were randomly assigned to simultaneous virtual patient education with concurrent prescription of SGLT2i or GLP1-RA (ie, Simultaneous) or 2 months of virtual education followed by medication prescription (ie, Education-First) delivered by a multidisciplinary team driven by nonlicensed navigators and clinical pharmacists who prescribed SGLT2i or GLP1-RA using a standardized treatment algorithm. The primary outcome was the proportion of patients with prescriptions for either SGLT2i or GLP1-RA by 6 months.

RESULTS:

Between March 2021 and December 2022, 200 patients were randomized. The mean age was 66.5 years; 36.5% were female, and 22.0% were non-White. Overall, 30.0% had cardiovascular disease, 5.0% had cerebrovascular disease, and 1.5% had both. Mean estimated glomerular filtration rate was 77.9 mL/(min‧1.73 m2), and mean urine/albumin creatinine ratio was 88.6 mg/g. After 2 months, 69 of 200 (34.5%) patients received a new prescription for either SGLT2i or GLP1-RA 53.4% of patients in the Simultaneous arm and 8.3% of patients in the Education-First arm (P<0.001). After 6 months, 128 of 200 (64.0%) received a new prescription 69.8% of patients in the Simultaneous arm and 56.0% of patients in Education-First (P<0.001). Patient self-report of taking SGLT2i or GLP1-RA within 6 months of trial entry was similarly greater in the Simultaneous versus Education-First arm (69 of 116 [59.5%] versus 37 of 84 [44.0%]; P<0.001) Median time to first prescription was 24 (interquartile range [IQR], 13-50) versus 85 days (IQR, 65-106), respectively (P<0.001).

CONCLUSIONS:

In this randomized trial, a remote, team-based program identifies patients with type 2 diabetes and high cardiovascular or kidney risk, provides virtual education, prescribes SGLT2i or GLP1-RA, and improves guideline-directed medical therapy. These findings support greater utilization of virtual team-based approaches to optimize chronic disease management. REGISTRATION URL https//www.clinicaltrials.gov; Unique identifier NCT06046560.
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Diabetes Mellitus, Type 2 / Sodium-Glucose Transporter 2 Inhibitors Limits: Aged / Female / Humans / Male / Middle aged Language: En Journal: Circulation Year: 2024 Type: Article Affiliation country: Morocco
Fulltext
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PubMed Links
Search on Google

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Diabetes Mellitus, Type 2 / Sodium-Glucose Transporter 2 Inhibitors Limits: Aged / Female / Humans / Male / Middle aged Language: En Journal: Circulation Year: 2024 Type: Article Affiliation country: Morocco