TY - JOUR
T1 - Gaps in evidence-based therapy use in insured patients in the united states with type 2 diabetes mellitus and atherosclerotic cardiovascular disease
AU - Nelson, Adam J.
AU - Ardissino, Maddalena
AU - Haynes, Kevin
AU - Shambhu, Sonali
AU - Eapen, Zubin J.
AU - McGuire, Darren K.
AU - Carnicelli, Anthony
AU - Lopes, Renato D.
AU - Green, Jennifer B.
AU - O’Brien, Emily C.
AU - Pagidipati, Neha J.
AU - Granger, Christopher B.
N1 - Funding Information:
Dr Carnicelli reports research funding from the National Institutes of Health T32 training grant. Dr Nelson reports research funding from Diabetes Australia and the Royal Australasian College of Physicians. Dr Granger reports research grants from Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Daiichi Sankyo, Janssen, Pfizer, Armetheon, AstraZeneca, US Food & Drug Administration, GlaxoSmithKline, The Medicines Company, Medtronic Foundation, Medtronic Inc., and Novartis; and consulting fees from Bayer, Boehringer Ingelheim, Boston Scientific, Bristol-Myers Squibb, Daiichi Sankyo, Janssen, Pfizer, Abbvie, Armetheon, Astra Zeneca, Eli Lilly, GlaxoSmithKline, Hoffmann-La Roche, The Medicines Company, National Institutes of Health, Novartis, Sirtex, Verseon, Apple, Medscape LLC, Merck, Novo Nordisk, Roche Diagnostics, and Rho Pharmaceuticals. Dr McGuire reports clinical trial leadership for AstraZeneca, Sanofi Aventis, Janssen, Boehringer Ingelheim, Merck & Co, Pfizer, NovoNordisk, Lexicon, Eisai, GlaxoSmithKline, and Esperion; consulting fees from AstraZeneca, Sanofi Aventis, Lilly US, Boehringer Ingelheim, Merck & Co, Pfizer, Novo Nordisk, Applied Therapeutics, Afimmune, and Metavant. Dr O’Brien reports research grants from Novartis, Bristol-Myers Squibb, and Novo Nordisk. Dr Green reports research grants from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, and Sanofi; and consulting fees from AstraZeneca, Merck, Boehringer Ingelheim, Sanofi/Regeneron, and NovoNordisk. Dr Haynes is an employee of Anthem. Dr Pagidipati reports research grants from Regeneron Pharmaceuticals, Sanofi-Aventis, Boehringer Ingelheim, NovoNordisk, and Verily Life Sciences. Dr Lopes reports research grants from Bristol-Myers Squibb, Pfizer, Amgen, Inc., GlaxoSmithKline, Medtronic PLC, and Sanofi Aventis; and consulting fees from Bristol-Myers Squibb, Pfizer, Boehringer Ingelheim, and Bayer AG. Shambhu is an employee of Anthem. Dr Eapen is an employee of Anthem. Ardissino has no disclosures to report.
Funding Information:
This manuscript was funded internally by the Duke Clinical Research Institute (Durham, NC).
Publisher Copyright:
© 2021 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
PY - 2021/1/19
Y1 - 2021/1/19
N2 - 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.
AB - 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.
KW - Atherosclerotic cardiovascular disease
KW - Diabetes mellitus
KW - Evidence-based
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U2 - 10.1161/JAHA.120.016835
DO - 10.1161/JAHA.120.016835
M3 - Article
C2 - 33432843
AN - SCOPUS:85100125531
SN - 2047-9980
VL - 10
SP - 1
EP - 7
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 2
M1 - e016835
ER -