Hackensack University Medical Center Shared Learning QI Update - March 16, 2021

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In this session Dr. Colette Knight presents an overview and updates on HUMC’s quality improvement project on the use of SGLT2-inhibitor (SGLT2i) and GLP receptor agonist (GLP-RA) in patients with atherosclerotic cardiovascular disease (ASCVD) or heart failure.

The Goal of this project is to improve care and management of Cardiology patients with diabetes. Patient section criteria for the pilot project included type 2 diabetes with A1c≥7%, microalbuminuria or proteinuria, elevated LDL (≥100), current tobacco use, blood pressure ≥140/80, and/or coronary artery disease and congestive heart failure.

Pilot project outcomes:

  • 54 patients were identified; 14 of these were prescribed an SGLT2-inhibitor (most commonly Farxiga or empagliflozin), 8 were prescribed a GLP receptor agonist, and 2 were started on both types of medication. SGLT2i was discontinued for 3 patients (urinary tract infection, atypical ketoacidosis).
  • Cardiologist/cardiology fellow Impressions: concern about providing diabetes care; cost out of reach for many patients.
  • Patient perspectives: positive impressions included better control of weight and blood pressure, less lower leg edema; negative aspects included drug cost, no effect of drug on lowing glucose levels, and urinary tract infection.

Key Learnings: Ensuring optimal care management for patients with diabetes and coronary artery disease/congestive heart failure will require that providers be better equipped. Integrated Endocrinology and Cardiology teams with Advanced Practice Nurses will be needed to educate clinicians and patients, develop workflows, ensure implementation of appropriate medications prior to inpatient discharge, and create transitional care plans.

Future Plans include efforts to assure that SGLT2-inhibitors and GLP-RAs are included on formularies and that protocols are established to ensure that these drugs are prescribed to appropriate patients.


Colette M. Knight, MD
Chair, Diabetes Institute
Division Director Endocrinology
Hackensack University Medical Center


Gregory S. Liptak
Vice President, Quality Improvement Services
American Diabetes Association

Presentation: 51:43



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