AMGA Study Reveals Low Adoption of Clinical Guidelines for Managing Cardiovascular Risk in Patients with Type 2 Diabetes

Alexandria, VA – According to findings from a qualitative study conducted by AMGA, clinicians at four U.S. healthcare organizations are either unaware or uncomfortable with current treatment guidelines on managing patients with Type 2 diabetes (T2DM) who are at risk for cardiovascular disease (CVD). The study, funded by Novo Nordisk Inc., was featured in the April 2021 issue of the Journal of Ambulatory Care Management.

The authors found barriers to guideline adoption at the system, provider, and patient levels. System-level barriers included lack of standardized processes for dissemination of information within health systems often leading to a disconnect between leadership and frontline providers around available resources and information, such as care and treatment pathways. The study was conducted with over 400 clinicians at four U.S. healthcare organizations (HCOs).

“The disconnect in perceptions between practicing clinicians and administrators on the understanding and use of the ADA [American Diabetes Association] clinical guidelines, along with awareness and use of treatment protocols, was striking,” stated Elizabeth Ciemins, AMGA vice president for research and analytics.

At the provider-level, lack of awareness and knowledge about the guidelines and their content was apparent. Less than a quarter of respondents (20.4%) were “extremely” familiar with the 2019 ADA Standards of Care for Cardiovascular Disease and Risk Management in patients with T2DM, which recommends use of SGLT-2 (sodium-glucose cotransporter-2) inhibitors and GLP-1 RAs (glucagon-like peptide-1 receptor agonists) as second-line agents for people with T2DM with, or at risk for, cardiovascular disease. Several barriers were identified, including insufficient education and training around new guidelines.

According to AMGA President and CEO Jerry Penso, “The study demonstrates the need for more training and education of clinicians around the newer medications and the ADA clinical guidelines.”

Lack of insurance coverage for the patient was identified as a major barrier to use of the medications recommended in the guidelines for this high-risk population (i.e., those with, or at risk for, CVD).

Health systems play an important role in the uptake of new guidelines and may be able to accelerate adoption of evidence-based guidelines by developing and disseminating care or treatment pathways and integrating the guidelines into regular care. Opportunities also exist to leverage technology and data to identify, monitor, and track prescribing patterns for patients most in need of the CVD benefit in the newer medications. Early adopters may be instrumental in increasing the comfort level of all clinicians with use of new guidelines. Finally, health systems might provide incentives for use of best practices and adherence to clinical guidelines (e.g., as quality performance measures).

“This study provides valuable insight into the various factors that are impacting the uptake of these clinical guidelines despite the proven benefit that GLP-1 RAs and SGLT-2s may offer people living with type 2 diabetes who are at an increased risk of CVD. Novo Nordisk is committed to partnering with the AMGA and the medical community to help raise further awareness of clinical guidance to support optimal patient care,” said Anna Windle, VP Medical Affairs, Novo Nordisk Inc.

The adoption of clinical guidelines and integration into practice are complex processes. The study provides a better understanding of the processes by which guidelines are adopted and implemented and identifies factors that can hinder or accelerate their uptake. Attention to the many factors influencing acceptance and endorsement of guidelines is critical to ensuring their timely adoption.

As summarized by Ciemins, “Multiple factors influence the uptake and adherence to guidelines, and multiple stakeholders will need to work together to ensure robust processes are in place to effectively disseminate and implement this new evidence into practice.”


About AMGA
AMGA is a trade association leading the transformation of health care in America. Representing multispecialty medical groups and integrated systems of care, we advocate, educate, innovate and empower our members to deliver the next level of high performance health. AMGA is the national voice promoting awareness of medical groups’ recognized excellence in the delivery of coordinated, high-quality, cost-effective care. More than 175,000 physicians practice in our member organizations, delivering care to one in three Americans.


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