192-OR: Effect of Video Conferences between Endocrinologists and Family Doctors on Levels of Recommended Medication among Persons with Type 2 Diabetes—Pragmatic RCT

Abstract

Introduction and objective: To close treatment gaps in type 2 diabetes (T2D), a 2023 US National Clinical Care Commission calls for testing models of virtual collaboration. We examined the effect of video conferences between endocrinologists and family doctors on levels of recommended medication among persons with T2D seen in family practice. Methods: Two arm, pragmatic RCT with 25 family practices (mean no. of patients: 4,245) from Aarhus Municipality, Denmark (identified after inviting all 100), and one endocrinology department. Family practices were randomized 1:1 to usual phone-based hospital support or a sequence of four video conferences (45 min) with an endocrinologist over 12 months. Co-primary outcomes at months 12-15 were the proportion of persons with T2D and 1) ischemic heart disease and/or stroke receiving GLP1-RA and/or SGLT2 inhibitor; 2) micro/macro-albuminuria receiving ACE/AT2; and 3) LDL >2.5 mmol/L receiving statins. Secondary outcomes were the proportion below treatment cut-offs e.g.: HbA1c <58 mmol/L; systolic BP <140 mm Hg. Data were collected from electronic records and analyzed using t-tests. Results: Fourteen family practices were randomized to the intervention and 11 to usual support: no significant differences in practice characteristics. At the trial end, in the intervention and control groups: 65.2% and 47.6% of persons with T2D and ischemic heart disease and/or stroke received GLP1-RA and/or SGLT2 inhibitor (CI 4.6;30.7%); 94.7% and 95.8% of persons with T2D and micro/macro-albuminuria received ACE/AT2 (CI -2.8;0.6%); and 90.1% and 90.1% of persons with T2D and LDL>2.5 mmol/L received statins (CI -3.5;3.6%). We found no significant differences in secondary outcomes. Conclusion: Video conferences between endocrinologists and family doctors can close gaps in medication treatment for persons with T2D and CVD by accelerating knowledge diffusion and collaboration. Disclosure T. Prætorius: Research Support; Novo Nordisk Foundation. A.B. Lundberg: Other Relationship; Novo Nordisk Foundation. E.K. Fredslund: Consultant; Novartis Denmark. N.B. Rossen: None. S. Gregersen: None. A. Prior: None. E. Søndergaard: None. S.T. Knudsen: Other Relationship; Boehringer-Ingelheim, Sanofi, Mundipharma, Novo Nordisk A/S, Merck Sharp & Dohme Corp., Abbott, Bayer Inc. Research Support; Eli Lilly and Company. Speaker's Bureau; Eli Lilly and Company. A. Sandbæk: Board Member; Boehringer-Ingelheim. Funding Quality and Training Committee of Central Denmark Region (1-30-72-404-21); Novo Nordisk Foundation (NNF17SA0031230-1)