Abstract 127: Cardiovascular Risk and Outcomes in Patients with Diabetes: Using Medical Education to Improve Care

Abstract

Introduction: Mortality rates due to cardiovascular disease (CVD) are 2-4 times higher among people with diabetes than in those without. Glucose control reduces the risk of any CVD event by 42% and the risk of heart attack, stroke, or death from CVD by 57%. We assessed the hypothesis that continuing medical education (CME) improves knowledge and performance of cardiologists in managing glycemic control and other CV risk factors in patients with type 2 diabetes (T2D). Methods: Cardiologists who treat patients with coronary artery disease participated in at least 1 of 2 online CME activities within a curriculum on CV risks and outcomes in patients with T2D. Participant responses to a case-based survey after activity completion were compared with responses from demographically similar control groups of nonparticipants. Educational effect size was calculated using Cohen’s d formula, with a value of <0.4 representing a small effect, 0.4-0.8 a medium effect, and >0.8 a large effect. Results: Participating cardiologists (n = 151) were more likely to make evidence-based practice choices than were nonparticipating cardiologists. Activity 1: Improving CV Outcomes in Patients with T2D Multi-media format Increased Likelihood to Make Evidence-Based Practice Choices Post-Education: 33.5% Effect Size: 0.51 (N = 78) Activity 1: Assessing CV Risk in Patients with T2D Multi-media format Increased Likelihood to Make Evidence-Based Practice Choices Post-Education: 50.3% Effect Size: 0.87 (N = 73) Domain 1: Managing Glycemic Control and Other CV Risk Factors in Patients with CVD and T2D. Participating cardiologists significantly improved their consideration of comorbid conditions when deciding on a glucose management strategy (73% pre vs. 85% post) and selection of treatment for early intervention (85% pre vs. 96% post). Domain 2: Identification of Outcomes Data on Glucose-Lowering Agents in Patients with T2D and CVD. Participating cardiologists significantly improved in the recognition of antihyperglycemic agents shown in clinical trials to be safe for high risk CV patients (36% pre vs. 79% post) and in identification of the effect of saxagliptin on CV events in high risk CV patients with T2D (SAVOR TIMI 53 trial) (55% pre vs. 86% post). Domain 3: Application of Outcomes Data on Glucose-Lowering Agents in Patients with T2D and CVD. Participating cardiologists significantly improved in their selection of a DPP-4 inhibitor as the most appropriate antihyperglycemic agent for patients with T2D and CV risk factors or previous CV events (59% pre vs. 81% post and 53% pre vs. 73% post, respectively). Conclusion: This study demonstrated the success of a curriculum-style educational intervention using multimedia technology on improving knowledge and performance of cardiologists which can lead to enhanced management of CV risks and, thus, improved outcomes in patients with T2D and CVD.