SUN-149 Cardiologist vs. Endocrinologist Encounters in Patients with T2D and CVD: Potential Implications for Glucose-Lowering Therapy Use and Education

Abstract

Abstract Background: A large proportion of patients with type 2 diabetes (T2D) have established cardiovascular (CV) disease (D). Recent large CV outcome trials demonstrated clear CV benefits of 2 novel classes of glucose-lowering agents (GLA), SGLT2 inhibitors and GLP-1 receptor agonists. Guidelines now stipulate that these should be favored in patients with T2D and overt CVD. Not surprisingly, endocrinologists prescribe these GLAs more frequently than cardiologists. Some, however, have proposed that cardiologists should take a more active role in prescribing these GLAs for CV risk reduction. We therefore endeavored to compare prescribing opportunities for these GLAs, by assessing the likelihood that a patient with T2D and CVD had an outpatient encounter with a cardiologist vs. an endocrinologist over a 1-year period in a large academic healthcare system in New England. Methods: We reviewed electronic health records of adult patients (age ≥18) with T2D who had outpatient encounters within the Yale New Haven Hospital System (YNHHS) during 2017. We analyzed demographic information, CVD diagnostic categories (coronary artery disease [CAD], congestive heart failure [CHF], cerebrovascular disease [CBD], peripheral vascular disease [PVD]), number of cardiology and endocrinology encounters, provider types, and visit diagnoses. Results: Of 78,878 T2D patients (mean age 66.7 ±14.4 years; 51% female), 31,639 (40.1%) had established CVD. The ratio of cardiologist:endocrinologist outpatient encounters was 2.6 (51,954 vs. 20,337 encounters) for all T2D patients and 5.3 (43,482 vs. 8,264 encounters) for those with T2D and CVD. Of the 4 CVD diagnostic categories, patients with CHF had the highest cardiologist:endocrinologist encounter ratio at 8.4 (24,477 vs. 2,931 encounters), followed by patients with CAD at 6.0 (33,722 vs 5,579 encounters). Conclusion: In our health system, over the course of a single year, a patient with T2D was nearly 3 times more likely to have an outpatient encounter with a cardiologist than an endocrinologist. With coexisting CVD, the likelihood increased to greater than 5-fold. In order to capitalize on the CV benefits of the newer GLAs, prescriptions by cardiologists are apt to hasten adherence to the latest guidelines and improve patient outcomes. Educational programs pertaining to these emerging treatment paradigms should target cardiologists in addition to endocrinologists (and primary care physicians).