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Gaps in Evidence-Based Therapy Use in Insured Patients in the United States With Type 2 Diabetes Mellitus and Atherosclerotic Cardiovascular Disease.
- Source :
-
Journal of the American Heart Association [J Am Heart Assoc] 2021 Jan 19; Vol. 10 (2), pp. e016835. Date of Electronic Publication: 2021 Jan 12. - Publication Year :
- 2021
-
Abstract
- Background Evidence-based therapies are generally underused for cardiovascular risk reduction; however, less is known about contemporary patients with type 2 diabetes mellitus and atherosclerotic cardiovascular disease. Methods and Results Pharmacy and medical claims data from within Anthem were queried for patients with established atherosclerotic cardiovascular disease and type 2 diabetes mellitus. Using an index date of April 18, 2018, we evaluated the proportion of patients with a prescription claim for any of the 3 evidence-based therapies on, or covering, the index date ±30 days: high-intensity statin, angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, and sodium glucose cotransporter-2 inhibitor or glucagon-like peptide-1 receptor agonist. The potential benefit of achieving 100% adoption of all 3 evidence-based therapies was simulated using pooled treatment estimates from clinical trials. Of the 155 958 patients in the sample, 24.7% were using a high-intensity statin, 53.1% were using an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, and 9.9% were using either an sodium glucose cotransporter-2 inhibitor or glucagon-like peptide-1 receptor agonists. Overall, only 2.7% of the population were covered by prescriptions for all 3 evidence-based therapies, and 37.4% were on none of them. Over a 12-month period, 70.6% of patients saw a cardiologist, while only 18% saw an endocrinologist. Increasing the use of evidence-based therapies to 100% over 3 years of treatment could be expected to reduce 4546 major atherosclerotic cardiovascular events (myocardial infarction, stroke, or cardiovascular death) in eligible but untreated patients. Conclusions Alarming gaps exist in the contemporary use of evidence-based therapies in this large population of insured patients with type 2 diabetes mellitus and atherosclerotic cardiovascular disease. These data provide a call to action for patients, providers, industry, regulators, professional societies, and payers to close these gaps in care.
- Subjects :
- Comorbidity
Drug Utilization Review methods
Drug Utilization Review statistics & numerical data
Female
Health Services Needs and Demand
Humans
Male
Middle Aged
Referral and Consultation statistics & numerical data
United States epidemiology
Cardiovascular Agents classification
Cardiovascular Agents therapeutic use
Coronary Artery Disease complications
Coronary Artery Disease mortality
Coronary Artery Disease therapy
Diabetes Mellitus, Type 2 complications
Diabetes Mellitus, Type 2 epidemiology
Diabetes Mellitus, Type 2 therapy
Health Services Misuse prevention & control
Health Services Misuse statistics & numerical data
Hypoglycemic Agents classification
Hypoglycemic Agents therapeutic use
Professional Practice Gaps standards
Professional Practice Gaps statistics & numerical data
Subjects
Details
- Language :
- English
- ISSN :
- 2047-9980
- Volume :
- 10
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- Journal of the American Heart Association
- Publication Type :
- Academic Journal
- Accession number :
- 33432843
- Full Text :
- https://doi.org/10.1161/JAHA.120.016835