Report from the Scientific Poster Session at the 15th Annual Cardiometabolic Health Congress Live Online, USA, 21–24 October 2020

The 15th Annual CMHC Live Online concluded on Saturday, October 24th [...].

when compared to Black patients (86.8% vs. 77.2%). Only 26.2% of patients on statins had follow-up cholesterol levels for monitoring treatment efficacy.
Conclusions: Statin underprescription was seen in approximately one out of five eligible patients, and was independently associated with Black race, younger age, fewer comorbidities, and eligibility via 10-year ASCVD risk only. Hispanic patients were more likely to be on appropriate statin therapy compared to Black patients. Purpose: Spironolactone (SPIRO) reduces BP in patients with resistant hypertension (RHTN); however, its use in patients with advanced chronic kidney disease (CKD) is often limited by hyperkalemia. In AMBER, patiromer enabled more persistent use of SPIRO in patients with RHTN and CKD. As SPIRO is recommended in RHTN, and diabetes mellitus (DM) increases hyperkalemia risk, we report results in prespecified subgroups with Type 1 or 2 DM and without DM.
Method: AMBER was a randomized, double-blind, placebo (PBO)-controlled trial in adults with RHTN and eGFR 25 to ≤45 mL/min/1.73m 2 . Patients were assigned (1:1) to PBO or patiromer at a starting dose of 8.4 g once daily, and SPIRO 25 mg once daily. Dose titrations were permitted after 1 week for patiromer/PBO to address hyperkalemia or hypokalemia: upward adjustment to 16.8 g QD, and then 25.2 g QD for local laboratory serum K+ >5.1 mEq/L, and downward adjustment for serum K+ <4.0 mEq/L. Dose of SPIRO was increased to 50 mg QD at week 3 in patients with serum K+ ≤5.1 mEq/L if systolic AOBP remained ≥120 mmHg. The primary endpoint (between-group difference at week 12 in the percent of patients on SPIRO) was assessed prospectively in prespecified subgroups by DM status.
Results: Overall, 295 patients were randomized, 145 (49%) with DM and 150 (51%) without DM. Baseline mean (SD) serum K+ (mEq/L) was 4.76 (0.34) in patients with DM and 4.67 (0.39) in patients without DM. Significantly more patients treated with patiromer than with PBO remained on SPIRO at week 12. In the subgroup with DM, 83.6% of patients receiving patiromer remained on SPIRO at week 12 compared with 65.3% of patients receiving PBO (between-group absolute difference = 18.3%, 95% confidence interval (CI) 4.4−32.2; p = 0.0111). In the subgroup without DM, 87.8% of patients receiving patiromer remained on SPIRO at week 12, compared with 67.1% of patients receiving PBO (between-group absolute difference = 20.7%, 95% CI 7.8−33.7; p = 0.0024). The least squares mean (SE) cumulative SPIRO dose in both subgroups was higher with patiromer than PBO, by 438.7 (177.7) mg in the subgroup with DM and 317.8 (175.0) mg in the subgroup without DM. Adverse events occurred in 61% (PBO) and 60% (patiromer) of patients with DM and in 46% (PBO) and 51% (patiromer) of patients without DM. Four patients had serum magnesium <1.4 mg/dL between baseline and week 12 (none < 1.2 mg/dL), including three with DM (1 PBO, 2 patiromer) and one without DM (patiromer) patients. In two of these patients with DM, serum magnesium was below the lower limit of normal (LLN; 1.8 mg/dL) at baseline. None of these patients had cardiac arrhythmias temporally associated with low magnesium levels, neuromuscular abnormalities, or serum K+ below the LLN (3.5 mEq/L).
Conclusions: Patiromer enabled more patients with advanced CKD and RHTN to continue treatment with SPIRO, regardless of DM status. Rhode Islanders. In 2019, Neighborhood allowed for greater access on its Medicaid, Commercial, and MMP formularies for sodium-glucose cotransporter-2 inhibitors (SGLT2) and glucagon-like peptide-1 receptor agonist (GLP-1) medications. Since making the formulary updates, Neighborhood wanted to determine how providers and members had responded to the updated treatment guidelines. To achieve this objective, Neighborhood reviewed claims data to determine if SGLT2s or GLP-1s were added to medication regimens. Additionally, Neighborhood wanted to gain knowledge of its provider network's T2DM prescribing patterns in relation to a member's age, chronic kidney disease (CKD) status, or atherosclerotic cardiovascular disease (ASCVD) status. Securing and understanding these results will help Neighborhood determine how best to provide targeted provider education moving forward and, in turn, strengthen Neighborhood's ability to positively impact its member population.
Results: The analysis showed that 80.5% of members with T2DM identified (n = 7663) were on metformin, 38.2% were on a sulfonylurea, 31.1% were on a long-acting insulin, 12.8% were on a rapid-acting insulin, 10.5% were on a dipeptidyl peptidase-4 inhibitor (DPP-4), 10.3% were on a GLP-1, and 5.6% were on an SGLT2. Of members with CKD (n = 1115), 51.6% were on metformin, 48.9% were on a long-acting insulin, 33.5% were on a sulfonylurea, 27.1% were on a rapid-acting insulin, 13.2% were on a DPP-4, 11.4% were on a GLP-1, and 5.5% were on an SGLT2. Of members with ASCVD (n = 2625), 71.8% were on metformin, 39.1% were on a long-acting insulin, 36.6% were on a sulfonylurea, 17.5% were on a rapid-acting insulin, 12.6% were on a DPP-4, 10.9% were on a GLP-1, and 6.4% were on an SGLT2. Of members 65 years of age and older (n = 1912), 70.4% were on metformin, 37.3% were on a sulfonylurea, 31.5% were on a long-acting insulin, 17% were on a DPP-4, 14.6% were on a rapid-acting insulin, 6% were on a GLP-1, and 4.9% were on an SGLT2. Of members 40 to 64 years of age (n = 5142), 83.7% were on metformin, 39.5% were on a sulfonylurea, 30.7% were on a long-acting insulin, 11.8% were on a rapid-acting insulin, 11.4% were on a GLP-1, 8.6% were on a DPP-4, and 6% were on an SGLT2. Of members under 40 years of age (n = 609), 85.1% were on metformin, 33.7% were on a long-acting insulin, 30.5% were on a sulfonylurea, 15.6% were on a rapid-acting insulin, 14.1% were on a GLP-1, 6.7% were on a DPP-4, and 4.9% were on an SGLT2.
Conclusions: For the identified members with T2DM, metformin is the most utilized anti-diabetic medication, followed by sulfonylureas and long-acting insulins. Although this may have been a previous ADA-recommended treatment strategy, it is no longer current. In regard to members with CKD, although it makes sense that only 51.6% of the patients are taking metformin (potentially due to low creatinine clearance levels), further analysis will need to occur for the 33.5% of patients taking a sulfonylurea to ensure appropriate utilization. Additionally, younger patients (under 40 years old) are more likely to be on a GLP-1 (14.1% vs. 11.4% and 6%) and less likely to be on a sulfonylurea (30.5% vs. 39.5% and 37.3%) or a DPP-4 (6.7% vs. 8.6% and 17%) compared to members 40 to 64 or over 65 years old, respectively. Within these age group comparisons, each age group was similar in their utilization of long-acting insulin (33.7% vs. 30.7% vs. 31.5%) and rapid-acting insulin (15.6% vs. 11.8% vs. 14.6%). This analysis helps to understand that changes in guidelines do not immediately lead to changes in utilization and provides a blueprint for Neighborhood to help ensure appropriate T2DM treatment. Purpose: Chronic conditions such as diabetes can prove to be burdens for patients with little to no access to constant healthcare. Such conditions must be monitored to prevent further harm to the patients' wellbeing. Clinics such as the Apopka Farmworkers Clinic provide free care at the Farmworkers' Association of Florida in Apopka four times a year and now biweekly as telehealth. At the clinic, patients visit to receive routine work ups with the internal medicine team, vaccines, and specialized care. Diabetes has been found to be one of the top four most seen conditions at the clinic, the others being obesity, hypertension, and high cholesterol. Such conditions are chronic and should be monitored to prevent adverse outcomes with routine and adequate healthcare, most of which these patients do not receive elsewhere. Thus, by providing care, education, and prescribing lifesaving drugs, the clinic is able to aid these patients with their chronic conditions and prevent further complications. This project looks at how the clinic provides the standard of care (SOC) as dictated by the American Diabetes Association (ADA) for diabetic patients. It aims to reveal adherence to guidelines for these underserved patients, and determine if the free clinic provides them with the same quality of care as our hospital counterparts.
Method: The objective of this project is to see if the Apopka Farmworkers Clinic follows our SOC as stated by the ADA. The study conducted will be an analysis of patients presenting with diabetes at the Apopka Farmworkers Clinic from 2018 to 2020. Visits studied will include all clinic visits and telehealth visits conducted during this time period. Measurements at their visits will be retrospectively reviewed to determine the tests that were ordered and noted in charts. Adherence to SOC will be determined based on five criteria set out by the ADA: metabolic control, cardiovascular assessment, complications, lifestyle, and immunizations. Metabolic control covers HbA1c and other glucose measurements, if taken. Cardiovascular assessment includes blood pressure and lipid profile, including LDL, HDL, and triglycerides. Complications include retinopathy, and nephropathy, and others conditions, which should be checked or referred to our specialty clinics when available. The lifestyle component includes exercise monitoring and reporting. Lastly, immunizations determine if the influenza and pneumococcal vaccines have been administered. The variables studied will fall under these categories and include HbA1c, lipid panel tests, blood pressure, demographical information, family histories, immunizations, and specialist evaluations from the clinic visits. A score will be given for each patient's care plan during their visit with one point for each of the five categories listed.
Results: The retrospective chart review of 24 diabetic patients revealed an average age of 54.38 (Â ± 13.65) years. There were 7 males and 17 female patients observed. The race breakdown was 20.83% Caucasian, 25.00% African American, 20.83% Hispanic, and 29.16% unreported. Further analysis will be conducted to determine patients whose care adhered to all five categories of diabetic monitoring, 4 of the 5 categories, and so on. The category most fulfilled for patient visits will also be noted to determine which area the clinic consistently provides care in, as dictated by the ADA's SOC.
Conclusions: These results will aid in aligning our clinic's procedures with the ADA's SOC for patients with diabetes to ensure clinic patients are receiving the same level of care as those at other locations. Results will also show the degree of uncontrolled diabetics present in our free clinic versus the national average based on lab results. We hope to improve the care of diabetic patients entering our clinic through this project by analyzing the current standard of care and comparing ours to the standards set by the ADA. This knowledge will provide information to future clinics and physicians who serve this patient population. Purpose: In regard to morbidity and mortality, cardiovascular diseases are the most common causes worldwide. They form part of non-communicable chronic diseases (NCDs) and in Argentina they represent the most prevalent cause of death (39.3%). Smoking, inadequate feeding, physical inactivity and the harmful use of alcohol are the result of personal and social behavior acquired and influenced by the environment, the availability and promotion of harmful products (tobacco, alcohol, unhealthy food and drinks, with high levels of sugar, fat and salt). These toxic habits such as smoking, or cultural habits such as sedentary lifestyle and other illnesses such as hypertension, dyslipidemia, diabetes, overweight and obesity constitute the risk factors developing cardio-vascular diseases. The object of this study was to assess the current prevalence of cardiovascular risk factors within the staff of the Hospital San Martin of Parana, to carry out a comparison with the previous study in 2014 as well as with the fourth national survey of risk factors (2018) to monitor the evolution of the main risk factors.
Method: In total, 400 people were studied through anonymous self-administered surveys. The data required were essential to determine age, sex, size, weight, arterial hypertension or hypotensive treatment, overweight or obesity, sedentary lifestyle, diabetes, dyslipidemia or smoking. Smokers were also asked to complete the Modified Fagestrom Test to value the degree of nicotine dependence. The surveys were answered by health professionals, administrators, nursing staff and general services. The Stata statistical software was implemented for the descriptive analysis of the sample and to prove the hypothesis of difference between risk factors in a previous evaluation and in the national survey. There, the work was carried out with a test of independence and with differences within proportions.
Results: Proportionally, 65% of this sample corresponds to women and 35% to men; 53% of this sample is within the 20-40-year-old range; 3% is 61 years old or over; and the rest (44%) are between 41 and 60 years old. Prevalence of arterial hypertension represented 17%, while overweight and obesity accounted for 51%. Sedentary lifestyle was observed in 52% of the surveyed people. Diabetes prevalence was 7% while 15% presented dyslipidemia antecedents. Smoking prevalence corresponded to 27%, 63% denoted low dependence on nicotine and only 7% of the same group presented high dependence. In regard to the relation between risk and sex factors, there was a greater prevalence of obesity and smoking in men. The group aged 61 and over presented a prevalence in all risk factors except in obesity at which there is a higher prevalence in the 41-50-year-old group. In respect of the younger ones (20-40 years old) the most notable risk factors were sedentary lifestyle and smoking. Comparing the evaluation carried out in 2013 over a sample of 448 people of similar distribution regarding sex and age, sedentary lifestyle was the most different factor corresponding to 35% in 2013, against 52% at present. A comparison of these results with those of the national survey concluded that sedentary lifestyle and overweight /obesity were the most prevalent; though in a smaller percentage, a higher percentage of smokers than in the National survey (28% vs. 22.2%) was observed, as was a lesser prevalence of hypertension, dyslipidemia, and diabetes in hospital population.
Conclusions: The risk factors mentioned before were compared in regards to the previous study carried out in 2014, all with a 5% level of significance and it was statistically proved that there had been an increase in sedentary lifestyle which went from 35% to 52% (value p = 0.000001). The remaining risk factors showed insignificant statistical differences, thus, no variation existed. The p values obtained were: obesity (p = 0.21), hypertension (p = 0.71), diabetes (p = 0.37) smoking (p = 0.20) and dyslipidemia (p = 0.17). Concerning the last sample considered, a test of independence was done to determine if the risk factors depended on sex and age. The conclusion was that there exists independence with a value p = 0.3362 for sex and dependence for age (p < 0.001). When carrying out a test of the hypothesis of proportions, equality of prevalence was demonstrated in hypertension, sedentary lifestyle, diabetes and dyslipidemia with p values of 0.88, 0.76, 1.00 and 0.08, respectively, according to sex. Obesity and smoking are statistically different for sex. The differences between the average of national surveys and those carried out at Hospital San Martín (HSM) were statistically proved in terms of hypertension, dyslipidemia, overweight /obesity and diabetes factors. The first two factors showed values inferior to 0.0000001, while overweight/obesity and diabetes had p values of 0.003. The other two factors (sedentary lifestyle and smoking) cannot prove to be different from the national media attained in the surveys. Upon the analysis of the results, it can be stated that the factor prevalence favoring cardiovascular diseases has kept similar levels with time while sedentary lifestyle and overweight /obesity have augmented.
Purpose: A multidisciplinary team approach to diabetes management involves various healthcare members to optimize patient outcomes. However, there are limited studies that look at the effect of a multidisciplinary team on diabetes outcomes outside of endocrinology services. This study aimed to evaluate the impact of a primary care multidisciplinary team on glycemic control and additional risk reduction during a 12-week diabetes program.