Coordinating Cardiology clinics randomized trial of interventions to improve outcomes (COORDINATE) – Diabetes: rationale and design

• Published in: The American heart journal 2023-02, Vol.256, p.2-12
• Main Authors: Nelson, Adam J., Pagidipati, Neha J., Kelsey, Michelle D., Ardissino, Maddalena, Aroda, Vanita R., Cavender, Matthew A., Lopes, Renato D., Al-Khalidi, Hussein R., Braceras, Rogelio, Gaynor, Tanya, Kaltenbach, Lisa A., Kirk, Julienne K., Lingvay, Ildiko, Magwire, Melissa L., O'Brien, Emily C., Pak, Jonathan, Pop-Busui, Rodica, Richardson, Caroline R., Levya, Monica, Senyucel, Cagri, Webb, Laura, McGuire, Darren K., Green, Jennifer B., Granger, Christopher B.
• Format: Article
• Language: English
• Subjects: Angiotensin; Angiotensin-converting enzyme inhibitors; Arteriosclerosis; Atherosclerosis; Cardiology; Cardiology - methods; Cardiology Service, Hospital - organization & administration; Cardiovascular disease; Cardiovascular diseases; Cardiovascular Diseases - drug therapy; Cardiovascular Diseases - prevention & control; Clinical medicine; Clinics; Collaboration; Design; Diabetes; Diabetes mellitus; Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - drug therapy; Distance learning; Electronic health records; Enzyme inhibitors; GLP-1 receptor agonists; Glucagon; Glucagon-like peptide 1; Glucagon-Like Peptide-1 Receptor; Humans; Hypoglycemic Agents - therapeutic use; Intervention; Pandemics; Patients; Peptidyl-dipeptidase A; Primary care; Receptors; Sodium-glucose cotransporter; Sodium-Glucose Transporter 2 Inhibitors - therapeutic use; Statins; United States
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/j.ahj.2022.10.079

Several medications that are proven to reduce cardiovascular events exist for individuals with type 2 diabetes mellitus (T2DM) and atherosclerotic cardiovascular disease, however they are substantially underused in clinical practice. Clinician, patient, and system-level barriers all contribute to these gaps in care; yet, there is a paucity of high quality, rigorous studies evaluating the role of interventions to increase utilization. The COORDINATE-Diabetes trial randomized 42 cardiology clinics across the United States to either a multifaceted, site-specific intervention focused on evidence-based care for patients with T2DM or standard of care. The multifaceted intervention comprised the development of an interdisciplinary care pathway for each clinic, audit-and-feedback tools and educational outreach, in addition to patient-facing tools. The primary outcome is the proportion of individuals with T2DM prescribed three key classes of evidence-based medications (high-intensity statin, angiotensin converting enzyme inhibitor or angiotensin receptor blocker, and either a sodium/glucose cotransporter-2 inhibitor (SGLT-2i) inhibitor or glucagon-like peptide 1 receptor agonist (GLP-1RA) and will be assessed at least 6 months after participant enrollment. COORDINATE-Diabetes aims to identify strategies that improve the implementation and adoption of evidence-based therapies.