MCT2D Clinician Decision Aid User Guide

: August 27, 2024
: MCT2D

Table of Contents

MCT2D Clinician Decision Aid
INFORMATION
BACKGROUND
METHODS
RESULTS
SUMMARY & CONCLUSIONS
REFERENCES
Documents / Resources
- Read User Manual Online (PDF format)
- Download This Manual (PDF format)

MCT2D Clinician Decision Aid

INFORMATION

Trends in Guideline-Directed Medical Therapy for Type 2 Diabetes in a Statewide Quality Collaborative Between 2018-2023

Kara Mizokami-Stout, MD MSc1,2,3, Katherine L. Khosrovaneh, MPH1, Neha Bhomia, MHI1, Heidi L. Diez, PharmD, BCACP1 , Dina Griauzde, MD1,2, Noa Kim, MSI1, Joyce M. Lee, MD1, Lauren Oshman, MD, MPH1,3, Jacqueline Rau, MHSA1, Jacob Reiss, MHSA1, Larrea Young, MDes1, Julian Weisensel, BFA1, Rodica Pop-Busui MD, PhD1

Michigan Collaborative for Type 2 Diabetes (MCT2D)

(1) University of Michigan, Ann Arbor, MI (2) Veterans Affairs Healthcare System, Ann Arbor, MI (3) Institute for Healthcare Policy and Innovation (IHPI). Ann Arbor, MI

BACKGROUND

Since 2021, the Michigan Collaborative for Type 2 Diabetes (MCT2D) aims to improve guideline-directed medical therapy (GDMT) for type 2 diabetes (T2D).
MCT2D enrolls physician organizations who recruit their primary care, endocrinology, and nephrology practices.
As of December 2023, MCT2D had 339 total participating practices, of which 310 (91%) were primary care (PC) and 19 (6%) were endocrinology (Endo). This represents 18% of total PC practices (1728 practices total) and 34% of total endo practices across the state (56 practices total).
We examined trends in glucagon-like peptide-1 receptor agonist (GLP-1 RA) and sodium-glucose cotransporter-2 inhibitor (SGLT2i) prescribing rates for T2D amongst PC and Endo practices enrolled in MCT2D.

AIM

To examine trends in prescription claims for GDMT for T2D in PC and Endo practices enrolled in MCT2D from 2018 to 2023.

METHODS

We analyzed pharmacy claims data from adults (≥ 18 years) with T2D who received care in an MCT2D-participating practice (PC=298; Endo=19) between 2018-2023. T2D was defined by the following criteria from clinical or claims data:
- Type 2 diabetes diagnosis
- Most recent clinical hemoglobin A1c (HbA1c) ≥ 6.5% or most recent claim HbA1c > 7.0%
- Diabetes medications such as metformin, insulin, GLP-1 RA, SGLT2i, etc filled in the last 6 months
All subjects were insured by either Blue Cross Blue Shield of Michigan Preferred Provider Organization, Blue Care Network, or their Medicare Advantage plans.
Participating practice counts were pulled from the MCT2D participation registry. Total Michigan practice counts were determined from the BCBSM Physician Group Incentive Program list, which lists all physicians and practices by specialty type. Specialty type was filtered to “endocrinology” to identify Endo practices and to “internal medicine” and “family medicine”, removing hospitalist, pediatric, and emergency medicine practices to identify PC practices. Twelve participating PC practices were not submitting data and were not included in the analysis.
Descriptive statistics were used to examine differences in pharmacy claims for diabetes medications between PC and Endo practices, stratified by indications for SGLT2i (CKD, defined by diagnostic codes) or GLP-1 RA (overweight and obesity, defined by BMI ≥ 27).

Prescribing of guideline-directed medical therapy has steadily increased in PC and Endo practices throughout the state of Michigan

RESULTS

Among 38,437 persons with T2D (PC=37,361; Endo=1,076), 26% and 41% had claims for GLP-1 RA and 19% and 37% for SGLT2i, respectively.
Compared to 2018 prescription rates, GLP-1 RA increased by 17% and 22%, while SGLT2i prescriptions increased by 15% and 28% in PC and Endo practices respectively (Figures 3&4).
Figure 3. SGLT2i Status Amongst T2D Patients with Diagnosed Chronic Kidney Disease in PC and Endo Practices
Figure 4. GLP-1 RA Status in Patients with Body Mass Index (BMI) ≥ 27 in PC and Endo Practices

SUMMARY & CONCLUSIONS

Among practices participating in a statewide collaborative to improve treatment and outcomes for people with T2D, the use of GDMT has increased since 2018, particularly in Endo practices.
SGLT2i use is similar and GLP-1 RA use is 2-3-fold higher than rates reported in other studies.
Further exploration in the use of GDMT is needed for cardiovascular indications and as novel diabetes therapies are approved to better understand gaps in T2D care.

REFERENCES

American Diabetes Association Standards of Care in Diabetes 2024, Diabetes Care 2024; Volume 47, Issue 1.
Hussain A, Ramsey D, Lee M, Mahtta D, Khan MS, Nambi V, Ballantyne CM, Petersen LA, Walker AD, Kayani WT, Butler J, Slipczuk L, Rogers JG, Bozkurt B, Navaneethan SD, Virani SS. Utilization Rates of SGLT2 Inhibitors Among Patients With Type 2 Diabetes, Heart Failure, and Atherosclerotic Cardiovascular Disease: Insights From the Department of Veterans Affairs. JACC Heart Fail. 2023 Aug;11(8 Pt 1):933-942. doi: 10.1016/j.jchf.2023.03.024. Epub 2023 May 17. PMID: 37204363.
Mahtta D, Ramsey DJ, Lee MT, Chen L, Al Rifai M, Akeroyd JM, Vaughan EM, Matheny ME, Santo KRDE, Navaneethan SD, Lavie CJ, Birnbaum Y, Ballantyne CM, Petersen LA, Virani SS. Utilization Rates of SGLT2 Inhibitors and GLP-1 Receptor Agonists and Their Facility-Level Variation Among Patients With Atherosclerotic Cardiovascular Disease and Type 2 Diabetes: Insights From the Department of Veterans Affairs.
Diabetes Care. 2022 Feb 1;45(2):372-380. doi: 10.2337/dc21-1815. PMID: 35015080; PMCID: PMC8914426.
Nanna MG, Kolkailah AA, Page C, Peterson ED, Navar AM. Use of Sodium-Glucose Cotransporter 2 Inhibitors and Glucagonlike Peptide-1 Receptor Agonists in Patients With Diabetes and Cardiovascular Disease in Community Practice. JAMA Cardiol. 2023 Jan 1;8(1):89-95. doi: 10.1001/jamacardio.2022.3839. PMID: 36322056; PMCID: PMC9631221.
Nicholas SB, Daratha KB, Alicic RZ, Jones CR, Kornowske LM, Neumiller JJ, Fatoba ST, Kong SX, Singh R, Norris KC, Tuttle KR. Prescription of guideline-directed medical therapies in patients with diabetes and chronic kidney disease from the CURE-CKD Registry, 2019-2020. Diabetes Obes Metab. 2023 Oct;25(10):2970-2979. doi: 10.1111/dom.15194. Epub 2023 Jul 3. PMID: 37395334.

Support for MCT2D is provided by Blue Cross and Blue Shield of Michigan and Blue Care Network as part of the BCBSM Value Partnerships program. Although Blue Cross Blue Shield of Michigan and MCT2D work collaboratively, the opinions, beliefs and viewpoints expressed by the author do not necessarily reflect the opinions, beliefs and viewpoints of BCBSM or any of its employees.

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