Physicians across all medical specialties are aware that cardiovascular disease (CVD) is the leading cause of morbidity and mortality among patients with type 2 diabetes.
With the advent of novel antihyperglycemic agents with cardioprotective effects, why then is the majority of cardiologists caring for patients with concomitant CVD and diabetes reluctant to prescribe these drugs to their patients?[1,2,3,4,5,6]
Frequently Involved in Care More Than Ever Before
In both the inpatient and outpatient setting, cardiologists are frequently involved in the care of patients with diabetes. Robert Chilton, DO, at the University of Texas Health Science Center has seen a significant increase in the number of cardiology patients with diabetes. “I work in a cath lab as an interventional cardiologist, and 20 years ago, I would see one patient with diabetes every 2 weeks. Now, 80% of all my patients have diabetes.” He further noted that cardiologists will ultimately need to become more involved in diabetes care because there are not enough endocrinologists to care for the increasing number of patients diagnosed with the disease.
Cardiologists currently see more patients with diabetes than do endocrinologists, according to a study presented at the 2019 Endocrine Society Annual Meeting in New Orleans. Among 78,878 adults with diabetes, including 31,639 with CVD, visits to cardiologists outnumbered visits to endocrinologists almost threefold.[7] When considering only patients with diabetes and CVD, there were five times more cardiologist visits (n = 43,482) than endocrinologist visits (n = 8,624).
Despite these figures, many cardiovascular (CV) specialists report being poorly equipped to address diabetes with novel agents.[4] In response to this sentiment, there has been an increase in diabetes-related continuing education programs for cardiologists.
Opportunities for Collaboration
The American College of Cardiology (ACC) and the American Diabetes Association recommend specific diabetes therapies to decrease CVD risk.[8,9]As such, a substantial opportunity exists to improve quality of care and outcomes for patients with diabetes through a more collaborative system-of-care model.
The availability of diabetes therapies to lower patients’ risks of major adverse atherosclerotic events, heart failure, progression to renal disease, and premature CV death has resulted in a substantial increased interest in diabetes management across all medical specialties, including cardiology. Gregg Fonarow, MD, director of the Ahmanson-UCLA Cardiomyopathy Center, asserted, “A paradigm shift is needed to ensure that all clinicians involved in the care of patients with diabetes provide patients with optimal, evidence-based, guideline-directed care. This includes cardiologists.”
New Agents, Added Cardioprotective Benefits
Newer antihyperglycemic therapies, such as glucagon-like peptide-1 (GLP-1) receptor agonists and sodium-glucose contransporter-2 (SGLT-2) inhibitors, have proven CV safety profiles and CV event reduction properties that are not yet fully elucidated and apparently not related to glycemic control.[3,5,10,11] In addition to the cardioprotective benefits, SGLT-2s and GLP-1s are associated with weight loss, another modification that reduces morbidity in patients with CVD and diabetes.[12,13] [MORE]
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