The Diabetes Staging System (DSS): A Pilot Study Assessing Feasibility, Provider Engagement and Implementation Challenges of a Novel Staging System for Type 2 Diabetes.
Moahad S Dar, Junhong Zhang, Anna Ashline, Swetha Kota, Sandra Woolson, Nadya T Majette, Hayden B Bosworth
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Abstract
Introduction and objective: Type 2 diabetes (DM2) currently lacks a standardized staging system that can be used to predict survival and guide providers towards guideline concordant care much like TNM staging does for cancer. We conducted a pilot study to assess the feasibility, provider engagement and implementation challenges of the DSS and examined if guideline concordant care improved especially SGLT2i/GLP-1a use in Veterans DM2 patients with cardiorenal disease.
Methods: A 6-month pilot study implemented DSS in VA primary care clinics between December 2023-September 2024. Study visits were at baseline and 6 months. Primary outcome: the initiation of SGLT2i/GLP-1a in Veteran DM2 patients with CVD/CKD compared to baseline. Secondary outcomes: weight, blood pressure, hemoglobin A1C, glomerular filtration rate (GFR), and medication adherence compared to baseline. Inclusion criteria: Male or female Veterans between the ages of 18-75 years with DM2 and ≥1 CV event and/or CKD and not on SGLT2i/GLP-1a. Exclusion criteria: Veterans with contraindications to SGLT2i/GLP-1 and/or a serious mental health disorder.
Results: After baseline visit, all providers prescribed to 14/14 patients at least one of the medications with 12/14 prescribed SGLT2i and 2/14 prescribed GLP-1a. We found 13/14 (93%) patients to still be on at least one of the medications at 6 months. At 6 months compared to baseline, weight (216 lbs. ± 41 → 213 lbs. ± 39), blood pressure (141/76 ± 20/10 → 132/73 ± 17/10), A1C (7.7% ± 1.5% → 7.4% ± 0.8%) modestly decreased but GFR remained stable (64 mL/min ± 17 → 64 mL/min ± 19). Medication adherence was continued for all 13 patients (Medication possession ratio was ≥80%).
Conclusion: DSS use was associated with increased SGLT2i/GLP-1a prescribing by VA primary care providers and medication adherence in Veterans DM2 patients with CVD/CKD. The DSS could help improve cardiorenal outcomes and guideline concordant in their DM2 patients in the future if larger studies can validate these findings.
期刊介绍：
An international, peer-reviewed, open access, online journal. The journal is committed to the rapid publication of the latest laboratory and clinical findings in the fields of diabetes, metabolic syndrome and obesity research. Original research, review, case reports, hypothesis formation, expert opinion and commentaries are all considered for publication.
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