Background: Several sodium-glucose transport protein 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1 RA) reduce cardiovascular (CV) events and improve kidney outcomes in patients with type 2 diabetes (T2D); however, utilization remains low despite guideline recommendations.Methods: A randomized, remote implementation trial in the Mass General Brigham network enrolled patients with T2D at high CV and /or kidney risk. Patients eligible for, but not prescribed, SGLT2i or GLP-1 RA were randomly assigned to simultaneous virtual patient education with concurrent prescription of SGLT2i or GLP-1 RA ("simultaneous") or two months of virtual education followed by medication prescription ("education-first") delivered by a multi-disciplinary team driven by non-licensed navigators and clinical pharmacists who prescribed SGLT2i or GLP-1 RA using a standardized treatment algorithm. The primary outcome was the proportion of patients with prescriptions for either SGLT2i or GLP-1 RA by 6 months.Results: Between March 2021 and December 2022, 200 patients were randomized. Mean age was 66.5 years, 36.5% were female, 22.0% were non-White. Overall, 30.0% had cardiovascular CV disease, 5.0% had cerebrovascular disease, and 1.5% had both. Mean estimated glomerular filtration rate (eGFR) 77.9 mL/min/1.73m² and mean urine/albumin creatinine ratio (UACR) 88.6mg/g. After two months, 69/200 (34.5%) patients received a new prescription for either SGLT2i or GLP-1 RA: 53.4% of patients in the simultaneous arm vs. 8.3% of patients were in the education-first arm (p<0.001). After six months, 128/200 (64.0%) received a new prescription: 69.8 % of patients in the simultaneous arm vs. 56.0% of patients in education-first (p<0.001). Patient self-report of taking SGLT2i or GLP-1 RA within six months of trial entry was similarly higher in the simultaneous versus education-first arm (69 /116; 59.5% vs 37/84; 44.0%; p<0.001) Median time to first prescription was 24 (IQR 13, 50) vs 85 days (IQR 65, 106), respectively (p<0.001).Conclusions: In this randomized trial, a remote team-based program that identifies patients with T2D and high CV or kidney risk, provides virtual education, and prescribes SGLT2i or GLP-1 RA improves GDMT. These findings support greater utilization of virtual team-based approaches to optimize chronic disease management.

中文翻译：

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随机评估远程管理计划以改善指南指导的医疗治疗：糖尿病远程干预以改善循证药物的使用 (DRIVE) 试验

背景：几种钠-葡萄糖转运蛋白 2 抑制剂 (SGLT2i) 和胰高血糖素样肽 1 受体激动剂 (GLP-1 RA) 可减少 2 型糖尿病 (T2D) 患者的心血管 (CV) 事件并改善肾脏结局；然而，尽管有指南建议，利用率仍然很低。 方法：麻省总医院布里格姆网络开展的一项随机、远程实施试验纳入了心血管和/或肾脏风险较高的 T2D 患者。符合条件但未开具 SGLT2i 或 GLP-1 RA 处方的患者被随机分配接受同时虚拟患者教育，同时开出 SGLT2i 或 GLP-1 RA 处方（“同时”），或接受两个月的虚拟教育，然后开具药物处方（“教育”）。 -first”）由多学科团队提供，该团队由非执照导航员和临床药剂师驱动，他们使用标准化治疗算法开出 SGLT2i 或 GLP-1 RA 处方。主要结局是 6 个月前服用 SGLT2i 或 GLP-1 RA 处方的患者比例。 结果：2021 年 3 月至 2022 年 12 月期间，200 名患者被随机分组​​。平均年龄为 66.5 岁，其中 36.5% 为女性，22.0% 为非白人。总体而言，30.0% 的人患有心血管疾病，5.0% 的人患有脑血管疾病，1.5% 的人两者都有。平均估计肾小球滤过率(eGFR) 77.9 mL/min/1.73m ²和平均尿/白蛋白肌酐比(UACR) 88.6mg/g。两个月后，69/200 (34.5%) 患者接受了 SGLT2i 或 GLP-1 RA 的新处方：同步治疗组中的患者为 53.4%，而教育优先治疗组中的患者为 8.3% (p<0.001 ）。六个月后，128/200 (64.0%) 的患者接受了新处方：同时治疗组中的患者为 69.8%，而教育优先组中的患者为 56.0% (p<0.001)。患者自我报告在试验开始后 6 个月内服用 SGLT2i 或 GLP-1 RA 的比例在同时治疗组与教育优先组中同样较高（69 /116；59.5% vs 37/84；44.0%；p<0.001）第一次处方的时间分别为 24 天 (IQR 13, 50) vs 85 天 (IQR 65, 106) (p<0.001)。结论：在这项随机试验中，基于远程团队的计划可识别患有 T2D 和高 CV 的患者或肾脏风险，提供虚拟教育，并开出 SGLT2i 或 GLP-1 RA 处方来改善 GDMT。这些发现支持更多地利用基于虚拟团队的方法来优化慢性病管理。