Background: Persons with type 2 diabetes mellitus (T2DM) often experience fragmented and complex care and across multiple specialties. We implemented a patient-centered, multidisciplinary team-based intervention called CINEMA to improve care delivery and outcomes.
Methods: Patients with T2DM at high-risk for cardiovascular disease events, including those with established atherosclerotic cardiovascular disease, elevated coronary artery calcium score >100, chronic heart failure with reduced ejection fraction, and/or chronic kidney disease stages 2-4 were included in the program in Cleveland, OH. The program included 5 cardiologists with a special focus on T2DM, a pharmacist, a certified diabetes care and education specialist/dietician, a nurse navigator, and collaboration with endocrinologists and nephrologists. Data was collected from baseline within 3 months prior to patients’ first visit to up to 1 month after the follow-up visit. From May 2020 through May 2021, there were 316 referrals to the program. Of those referred, 47% met inclusion criteria. Among eligible patients, 96 (64%) completed a baseline and follow-up visit, with mean (std dev) follow-up time of 1 (34) days. Among patients completing the initial 3-month visit, 50% were ≥age 60 years with 48% female and 34% Black patients. Patients had significant reductions from baseline in Hb A1c (-8.7%) , total (-10.4%) , LDL (-15.7%) , and non-HDL (-14.9%) cholesterol, body weight (-3.7%) , and body mass index (-3.8%) (p<0.0for all) . In addition, among eligible patients, 87.5% were started on evidenced-based therapy with SGLT2i (n=24) , GLP-1 RA (n=40) , or both (n=20) to reduce the risk of CVD.
Conclusions: A team-based, patient-centered approach to high-risk disease management appears to be a promising paradigm for care delivery associated with greater use of evidence-based therapies and improved control of multiple CV risk factors.
I. Neeland: Advisory Panel; Boehringer Ingelheim International GmbH, Merck & Co., Inc. Consultant; Nestlé Health Science. S.G. Al-Kindi: None. N. Tashtish: None. S. Rahmani: None. D. Berg: None. M.N. Rana: None. C. Sullivan: None. B. Hatipoglu: None.