2023-P: From Guidelines to Practice: System-Level Adherence to Guideline-Directed Diabetes Therapies in Real-World Academic Practice

Introduction and Objective: Despite high prevalence of cardio-kidney-metabolic (CKM) burden in type 2 diabetes (T2D) and the ADA Standards of Care (SOC) recommending guidelines-directed medical therapies (GDMT) for CKM risk reduction, GDMT remain highly underused Methods: We leveraged a large tertiary academic health care center and a multi-disciplinary collaboration initiative to assess current practices and optimize diabetes care delivery across the entire health system. Main outcomes were current prescriptions of any of the following key GDMT: high-intensity statin, angiotensin-converting enzyme inhibitor (ACEi)/angiotensin-receptor blocker (ARB), sodium glucose co-transporter-2 inhibitors (SGLT-2i), glucagon-like peptide-1 receptor agonist (GLP-1RA). Results: Among 89,907 contemporary T2D adults (mean age 67 years, 50% female, 16% Hispanic/Black), 40% had established cardiovascular disease (CVD) [25% established atherosclerotic CVD (ASCVD),14.0% symptomatic heart failure (HF)], and 18 % had chronic kidney disease (CKD).Among T2D and established ASCVD, symptomatic HF or CKD, only 58%, 50% and 43% were prescribed a statin, and 35%, 36% and 37% were prescribed an ACEi/ARB respectively. Among those with established ASCVD only 11%,15% and 9% were prescribed a GLP-1 RA, SGLT2i or GLP-1 RA/SGLT2i combination, among those with HF only 10%, 22% and 11% were prescribed a GLP-1 RA, a SGLT2i or GLP-1 RA/SGLT2i, and among those with CKD, only 14% received a SGLT2i, 11% a GLP1-RA, and 9% combination respectively. Although 50% T2D individuals with CVD also had CKD-the highest-risk phenotype, only 28% were prescribed a GLP-1RA or SGLT2i. Conclusion: These real live data reveal substantial system-wide gaps in the use of GDMT and evidence-based care for T2D and established CKM. To address these gaps, we are implementing standardized, multifaceted, and workflow-integrated interventions aligned with the ADA SOC across the entire health system and reassess these metrics at 6&12 months to evaluate implementation impact Disclosure L. Nguyen: None. A. Carlson: None. E. Barclay: None. K. Childress: None. N. Mattingley: None. D. Odgers: None. S.T. Feist: None. J.B. Warren: Other - trainer for insertion techniques for use of Nexplanon contraceptive implant; Current; Organon. R. Hasan: None. R. Pop-Busui: Board Member; Current; American Diabetes Association. Consultant; Current; Averitas Pharma, Inc. Research Support; Current; Bayer AG. Consultant; Current; Lexicon Pharmaceuticals, Inc. Research Support; Current; National Institutes of Health. Consultant; Current; Novo Nordisk, Roche Diagnostics, Vertex Pharmaceuticals Incorporated. Consultant; Ended; Viatris Inc.