The Future of Cardiometabolic Care
By Arvind Sommi
In this ADA session, experts discussed comprehensive therapies, coordinated care, and the role of pharmacists in improving your health.
Heart failure is one of the most common complications of diabetes. Cardiologists at the ADA conference in San Diego discussed current gaps and their proposed solutions when treating diabetes and heart failure.
Faster clinical implementation of new research
Dr. Muthiah Vaduganathan, a cardiologist from Brigham and Women’s Hospital, highlighted the gaps in implementing comprehensive medical therapies for cardiometabolic diseases. He emphasized that despite the availability of therapies, implementation remains incomplete, slow, and inequitable.
He referenced the CHAMP-HF registry, which tracked individuals with heart failure with reduced ejection fraction (HFrEF). Only 1% received guideline recommended triple therapy at target doses, indicating clinical inertia and slow implementation of the guidelines. Additionally, he said that implementation was highly variable with Black and Hispanic people receiving SGLT-2 inhibitors at a much lower rate than most others. Dr. Vaduganathan emphasized the need to address these gaps and reduce the average 17-year delay between new evidence and practice change.
Training future cardiometabolic experts
Dr. Robert Eckel, an endocrinologist from the University of Colorado, discussed the challenges of managing cardiometabolic diseases, such as obesity and diabetes, which are often treated separately by different specialists. He advocated for the development of cardiometabolic fellowship programs to bridge the gap in training and improve patient care. “Not every person with diabetes needs to see an endocrinologist,” Dr. Eckel said. “We need more HCPs who can meet the complex needs of patients with cardiometabolic diseases.”
He proposed a three-step process: a cardiometabolic certificate program, a one-year or preferably two-year fellowship, and the establishment of a new cardiometabolic specialty. This comprehensive training would equip healthcare professionals to provide holistic care to patients with cardiometabolic conditions.
One stop shop – cardiometabolic center
Dr. Mikhail Kosiborod, a cardiologist from Saint Luke’s Hospital in Kansas City, began his talk by sharing an example of a person who was being seen by several specialists and taking many medications but still had an A1C over 11% and progressive diabetic kidney disease. He noted that despite having so many specialists working with her, there was a remarkable lack of coordination.
Dr. Kosiborod then presented the concept of a cardiometabolic center of excellence, aiming to provide coordinated, team-based care for patients with cardiometabolic diseases. This approach focuses on optimizing patient outcomes and improving adherence to guidelines. Dr. Kosiborod shared data from the center's initial implementation, showing significant improvements in patient care, including reductions in insulin use and better achievement of treatment targets in weight and lipids.
Getting pharmacists more involved
Dr. Lina Matta, a pharmacist from Brigham and Women’s Hospital, highlighted the role of pharmacists in population health management within cardiology. She discussed the importance of collaborative drug therapy management and the benefits of pharmacist-led interventions in achieving patient goals. She noted that “every pharmacist you interact with has taken a state exam and national exam” and that they often have much more time to spend discussing medications with people with diabetes.
She also introduced the idea of patient navigators, potentially college graduates on their way to medical school or another health-related career, who can be educated about specific diseases to facilitate communication with people with diabetes. By using patient navigators and digital technology, pharmacists can alleviate the burden on physicians and improve medication adherence and disease understanding. Pharmacist-led programs have shown promising results in managing conditions such as hypercholesterolemia, hypertension, and type 2 diabetes.
Bridging the gap in diabetes care
Last, Dr. Rohan Khera, a cardiologist and data scientist from the Yale School of Medicine, addressed the issue of equity in the use of medications for people with diabetes, highlighting the underuse of evidence-based therapies among high-risk populations.
His team found that people who were economically disadvantaged had a 13-20% lower chance of initiating SGLT-2/GLP-1 therapy and a 33-50% lower chance of remaining on the therapy after one year. Additionally, he noted that Black people had 28% lower odds of using SGLT-2s and 36% lower odds of using GLP-1s. He called for greater pharmacoequity, which he defined as when “all individuals receive optimal pharmacological care with treatment choices based exclusively on their clinical profile.”
His proposed solution entails automated quality of care measures, which would provide actionable, real-time assessment of care, targeted health policy interventions to remove financial barriers, and precision medicine.
He discussed how the integration of electronic clinical quality measurement and standardized algorithms across healthcare institutions can help improve the implementation of therapies. Additionally, personal diabetes care and the identification of patients who would benefit most from specific treatments can enhance treatment outcomes.
