Diabetes mellitus is a serious health issue and an economic burden, rising in epidemic proportions over the last few decades worldwide. Although several treatment options are available, only half of the global diabetic population achieves the recommended or individualized glycemic targets. Sodium-glucose cotransporter 2 (SGLT2) inhibitors are a new class of antidiabetic agents with a novel insulin-independent action. SGLT2 is a transporter found in the proximal renal tubules, responsible for the reabsorption of most of the glucose filtered by the kidney. Inhibition of SGLT2 lowers the blood glucose level by promoting the urinary excretion of excess glucose. Due to their insulin-independent action, SGLT2 inhibitors can be used with any degree of beta-cell dysfunction or insulin resistance, related to a very low risk of hypoglycemia. In addition to improving glycemic control, SGLT2 inhibitors have been associated with a reduction in weight and blood pressure when used as monotherapy or in combination with other antidiabetic agents in patients with type 2 diabetes mellitus (T2DM). Treatment with SGLT2 inhibitors is usually well tolerated; however, they have been associated with an increased incidence of urinary tract and genital infections, although these infections are usually mild and easy to treat. SGLT2 inhibitors are a promising new option in the armamentarium of drugs for patients with T2DM.

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The American Diabetes Association (ADA) and the American Heart Association launched a multi-faceted national partnership in 2018, Know Diabetes by Heart™, to reduce cardiovascular disease (CVD) deaths, heart attacks and strokes in people living with type 2 diabetes. To support this initiative, the ADA’s Diabetes INSIDE® (DI) program formed a mid-Atlantic quality improvement (QI) collaborative of five academic medical centers and a health information exchange (HIE) with partners from primary care, endocrinology, cardiology, nephrology, nursing, pharmacy, health IT, diabetes education, population health and industry. The collaborative’s goal is to accelerate clinical adoption of recent CVD findings using population health analytics, care system redesign, shared learning, provider and patient training, education, and community resources. DI works with each partner to identify, design and monitor quantifiable QI programs to address care quality gaps. The collaborative shared their initial findings and goals at a November 2019 meeting. Three systems identified opportunities to improve low use of SGLT2 inhibitors and GLP-1 agonists in eligible patients (∼12%) or departmental prescribing gaps between primary care and cardiology vs. endocrinology (SGLT2 5% vs. 11%; GLP-1 7.5% vs. 24.6%). Other gaps included coordinating care teams and communication between inpatient and outpatient settings both within and across overlapping health systems, a gap the HIE aims to address. Other systems are implementing DM screening in cardiology clinics or training cardiologists to assume a larger role in managing patients with DM and CVD. A system with a large racial/ethnic minority population is qualitatively evaluating the social, cultural, economic, and literacy factors that facilitate or inhibit optimal care. This regional collaborative across overlapping health systems offers increased opportunity to accelerate improvement of DM and CVD care for all patients and may serve as a model for other regions. Disclosure R.E. Furman: None. F. Hill-Briggs: None. A. Iwamaye: None. C. Knight: None. T. Kouvatsos: None. Y. Lev: None. I. Lorincz: None. W.M. Marella: None. D.J. Rubin: None. M.H. Schutta: Employee; Spouse/Partner; Merck & Co., Inc. D.A. Swavely: None. L. Ward: None. E.C. Furman: None. G. Liptak: Employee; Spouse/Partner; Janssen Pharmaceuticals, Inc. Funding Know Diabetes By Heart™; Boehringer Ingelheim and Eli Lilly and Company Diabetes Alliance; Novo Nordisk; Sanofi; AstraZeneca; Bayer