Provider adherence to American Diabetes Association cardiovascular risk–reduction guidelines: An integrative review

Abstract

Background: Diabetes mellitus (DM) requires comprehensive management to prevent end organ disease. Type 2 diabetes Mellitus (T2DM) effects more than 33.3 million individuals in the United States, the majority managed by primary care providers (PCPs). Type 2 diabetes Mellitus increases lifetime heart attack and stroke risk by 2–4 times. Adherence to the American Diabetes Association (ADA) cardiovascular disease reduction guidelines is associated with decreased morbidity and mortality. Purpose: This integrative review highlights PCP adherence to ADA cardiovascular risk–reduction guidelines and explores interventions that address adherence. Methodology: The integrative review approach demanded critical examination of the literature following extraction of findings obtained through a rigorous process involving clear inclusion and exclusion criteria. A comprehensive literature search was guided through Johns Hopkins Nursing Evidence-Based Practice Model. Data extraction was documented through Preferred Reporting Items for Systematic Reviews and Meta-Analysis. Results: Five articles met inclusion criteria. Articles ranged from 2017 to 2022 and occurred in the United States, Palestine, and one across Europe. Four areas of common content were identified and included the lack of adherence to statin prescribing, lack of adherence to blood pressure management, statin prescribing favoring male patients and those with existing atherosclerotic cardiovascular disease diagnoses, and varying methods to improve adherence. Conclusions: Quality-improvement strategies focused on the improvement of PCP adherence to ADA cardiovascular risk–reduction guidelines are necessary. Implications: Improved adherence would significantly improve morbidity and mortality outcomes in T2DM. Adherence interventions include education, electronic health record integration, and oversight by certified diabetes educator nurses. The time is now to reduce the negative sequelae from a disease that effects 11.3% of our population.