{"id":"b27ffd8ed35a","type":"article","url":"https://hartvaat.nl/2023/04/18/gecoordineerde-zorg-optimaliseert-cv-preventie-bij-type-2-diabetes-jama-rct/","title":"Gecoördineerde zorg optimaliseert CV-preventie bij type 2 diabetes: JAMA RCT","title_en":"Coordinated Care to Optimize Cardiovascular Preventive Therapies in Type 2 Diabetes: A Randomized Clinical Trial.","category":"preventie","category_label":"Preventie","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["diabetes-en-hart","primaire-preventie","select-trial","soul-trial"],"journal":"JAMA","doi":"10.1001/jama.2023.2854","source_url":"https://doi.org/10.1001/jama.2023.2854","authors":["Neha J Pagidipati","Adam J Nelson","Lisa A Kaltenbach","Monica Leyva","Darren K McGuire","Rodica Pop-Busui","Matthew A Cavender","Vanita R Aroda","Melissa L Magwire","Caroline R Richardson","Ildiko Lingvay","Julienne K Kirk","Hussein R Al-Khalidi","Laura Webb","Tanya Gaynor","Jonathan Pak","Cagri Senyucel","Renato D Lopes","Jennifer B Green","Christopher B Granger"],"significance":7,"published":"2023-04-18","source_date":"2023-04-18","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/diabetes-type-1-en-hart/","https://hartvaat.nl/kennis/preventie/preventie-bij-diabetes/"],"congress":"","summary_en":"This JAMA trial demonstrated that coordinated, multidisciplinary care significantly increases the use of evidence-based cardiovascular preventive therapies in patients with type 2 diabetes, translating guideline recommendations into clinical practice.","created":"2026-07-03T10:30:20Z","updated":"2026-07-03T13:29:24Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JAMA-trial toonde dat gecoördineerde, multidisciplinaire zorg het gebruik van evidence-based therapieën voor CV-preventie bij diabetes significant verhoogde. Statine-, SGLT2-remmer- en GLP-1-agonistgebruik stegen allen significant.","abstract_original":"IMPORTANCE: Evidence-based therapies to reduce atherosclerotic cardiovascular disease risk in adults with type 2 diabetes are underused in clinical practice. OBJECTIVE: To assess the effect of a coordinated, multifaceted intervention of assessment, education, and feedback vs usual care on the proportion of adults with type 2 diabetes and atherosclerotic cardiovascular disease prescribed all 3 groups of recommended, evidence-based therapies (high-intensity statins, angiotensin-converting enzyme inhibitors [ACEIs] or angiotensin receptor blockers [ARBs], and sodium-glucose cotransporter 2 [SGLT2] inhibitors and/or glucagon-like peptide 1 receptor agonists [GLP-1RAs]). DESIGN, SETTING, AND PARTICIPANTS: Cluster randomized clinical trial with 43 US cardiology clinics recruiting participants from July 2019 through May 2022 and follow-up through December 2022. The participants were adults with type 2 diabetes and atherosclerotic cardiovascular disease not already taking all 3 groups of evidence-based therapies. INTERVENTIONS: Assessing local barriers, developing care pathways, coordinating care, educating clinicians, reporting data back to the clinics, and providing tools for participants (n = 459) vs usual care per practice guidelines (n = 590). MAIN OUTCOMES AND MEASURES: The primary outcome was the proportion of participants prescribed all 3 groups of recommended therapies at 6 to 12 months after enrollment. The secondary outcomes included changes in atherosclerotic cardiovascular disease risk factors and a composite outcome of all-cause death or hospitalization for myocardial infarction, stroke, decompensated heart failure, or urgent revascularization (the trial was not powered to show these differences). RESULTS: Of 1049 participants enrolled (459 at 20 intervention clinics and 590 at 23 usual care clinics), the median age was 70 years and there were 338 women (32.2%), 173 Black participants (16.5%), and 90 Hispanic participants (8.6%). At the last follow-up visit (12 months for 97.3% of participants), those in the intervention group were more likely to be prescribed all 3 therapies (173/457 [37.9%]) vs the usual care group (85/588 [14.5%]), which is a difference of 23.4% (adjusted odds ratio [OR], 4.38 [95% CI, 2.49 to 7.71]; P < .001) and were more likely to be prescribed each of the 3 therapies (change from baseline in high-intensity statins from 66.5% to 70.7% for intervention vs from 58.2% to 56.8% for usual care [adjusted OR, 1.73; 95% CI, 1.06-2.83]; ACEIs or ARBs: from 75.1% to 81.4% for intervention vs from 69.6% to 68.4% for usual care [adjusted OR, 1.82; 95% CI, 1.14-2.91]; SGLT2 inhibitors and/or GLP-1RAs: from 12.3% to 60.4% for intervention vs from 14.5% to 35.5% for usual care [adjusted OR, 3.11; 95% CI, 2.08-4.64]). The intervention was not associated with changes in atherosclerotic cardiovascular disease risk factors. The composite secondary outcome occurred in 23 of 457 participants (5%) in the intervention group vs 40 of 588 participants (6.8%) in the usual care group (adjusted hazard ratio, 0.79 [95% CI, 0.46 to 1.33]). CONCLUSIONS AND RELEVANCE: A coordinated, multifaceted intervention increased prescription of 3 groups of evidence-based therapies in adults with type 2 diabetes and atherosclerotic cardiovascular disease. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03936660."}