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Introduction

Methods

Figure 1. Perceptions of the link between type 2 diabetes and CVD.Respondents with T2D (n=927) were asked how much they agree ordisagree with several CVD-related statements on a scale of 1-10. Shown isthe percentage of all respondents who answered in each scale bucket.

Results

Implications & Future Directions• Healthcare professionals should discuss CV risk with their T2D

patients. Just 46% of respondents had discussed CV risk with aPCP and the rate is lower for endocrinologists (17%), nursepractitioners (12%), diabetes educators (5%), and nutritionists (4%).

• There should be a focus on developing innovative solutions toknowledge gaps about the link between CVD and diabetes.Despite increased emphasis on CV outcomes in clinical trials, ameaningful proportion of people with T2D are still unaware of theirCV risk and of cardioprotective diabetes drugs.

• To make progress on this pressing issue, all stakeholders –including people with diabetes, healthcare professionals,regulators, payers, manufacturers, and policymakers – must beinvolved.

• Future questions and areas of inquiry include:1. How might healthcare professionals better incorporate

education about CVD and risk mitigation into patient visits?2. How do we improve access to and prescription frequency of

cardioprotective therapies?3. How do we promote earlier healthcare intervention and patient

engagement to lower risk and prevent CVD?

As one survey respondent eloquently summarized:“More preventative measures and less reactive –

this is too often overlooked…”

1The diaTribe Foundation, San Francisco, CA 2dQ&A Market Research, Inc., San Francisco, CA 3Close Concerns, San Francisco, CA 4Saint Luke's Mid America Heart Institute, Kansas City, Missouri 5 University of Washington, Seattle, WA

Keaton Stoner2, Emily Fitts1, Divya Gopisetty1, Ann Carracher3, Caterina Florissi2, Martin Kurian3, Jeemin Kwon1, Payal Marathe3, Peter Rentzepis3, Jonathan Rost2, Kelly Close1,3, Irl Hirsch5, Mikhail Kosiborod4, Richard Wood2

Insights from Type 2 Diabetes Patients Suggest Need for Cardiovascular Health Education

People with type 2 diabetes (T2D) are at an increased risk ofcardiovascular disease (CVD) [1,2] compared to people withoutdiabetes. The American Diabetes Association’s 2019 Standards ofMedical Care in Diabetes recommends annual assessment of anddescribes treatment for cardiovascular (CV) risk factors includingobesity/overweight, hypertension, dyslipidemia, smoking, chronickidney disease, albuminuria, and family history of premature coronarydisease [3]. Previous surveys have examined awareness of CVDamong people with T2D and their caregivers, finding thatmisconceptions about CV risk are common and that people withdiabetes want more information about reducing CV risk [4, 5].This patient survey focused on perceptions of CVD and cardio-protective therapies and whether people with T2D are taking steps tomitigate CV risk. Specifically, questions aimed to assess:1. Who is aware of the links between CVD and T2D?2. Who is aware of the cardioprotective effects of some diabetes

therapies?3. Are people with diabetes knowledgeable about and active in

taking steps to mitigate CV risk?4. Are healthcare professionals talking to their patients about the risk

of CVD and/or various means of cardioprotection?

In November 2018, 1,205 members of the dQ&A US Patient Panelwere invited to complete an online survey, which received responsesfrom 927 people living with type 2 diabetes over four days (77%response rate). Respondent demographics and health characteristicsare shown in Table 1. The survey assessed perceptions of CVD;awareness of and interest in diabetes drugs that reduce CVD risk;knowledge of their own health metrics; healthcare professionals seenand frequency of discussions about CVD; and self-assigned ‘grades’on lifestyle behaviors known to reduce CV risk. Respondentsreceived $5 USD for completing the survey. Data was collected withQualtrics, prepared with IBM SPSS, and analyzed in MarketSight.Descriptive statistics were calculated in MarketSight and visualized inMicrosoft Office.

• Potential to improve awareness of the cardioprotective capacityof SGLT-2 and GLP-1. 60% of respondents not on an SGLT-2 orGLP-1 were aware that some diabetes drugs can help protectagainst CVD. This rose to only 69% for those currently on an SGLT-2or GLP-1.

• Interest in SGLT-2 or GLP-1 beyond the rates at which they arecurrently being prescribed. Two-thirds of respondents said theywould take an additional diabetes drug if it also offered protectionagainst CVD. This roughly aligned with awareness of these drugs.

• Prevalent lack of education about CV risk. More than a third of ourstudy population had not discussed CV risk with any healthcareprofessional in the past year.

• Misalignment between risk factor awareness and behaviormodifications. For example, 100% of our cohort knew their bodyweight, but only 54% had a personal weight goal or target.Educational efforts must not stop at awareness; they should alsosuggest achievable goals for body weight, A1C, blood pressure, andLDL.

• Potential limitation is that in order to achieve a robust sample ofSGLT-2 and GLP-1 users, approximately 50% of respondent poolwas on one of these agents. This suggests a cohort with greateraccess than the general US T2D population. Hence, these resultsmay overestimate knowledge and awareness, further underscoringthe need for increased education.

• Overall, these results emphasize the unmet need for early andrepeated education about the connection between T2D andCVD.

Discussion & ConclusionsCV RISK AND CARDIOPROTECTIVE DIABETES DRUGS AWARENESS

KNOWLEDGE AND SCORING OF DIABETES AND CV METRICS

References1. Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies. The Lancet. 2019; 375(9733): 2215-2222. doi: 10.1016/S0140-6736.2. Impact of Diabetes Mellitus on Hospitalization for Heart Failure, Cardiovascular Events, and Death: Outcomes at 4 Years From the Reduction of Atherothrombosis for Continued Health (REACH) Registry. Circulation. 2015; 132(10):923-31. doi: 10.1161/CIRCULATIONAHA. 3. Cardiovascular Disease and Risk Management: Standards of Medical Care in Diabetes—2019. Diabetes Care. 2019; 42(Supplement 1): S103-S123. https://doi.org/10.2337/dc19-S010. 4. Taking Diabetes to Heart Survey – Global survey on CVD awareness and knowledge among people with type 2 diabetes. International Diabetes Federation. 2018. www.idf.org/takingdiabetes2heart. 5. The Association Between Type 2 Diabetes and Cardiovascular Disease: The "For Your SweetHeart™" Survey. Advances in therapy. 2019; 36(3):746-755. doi: 10.1007/s12325-019-0871-9.

Acknowledgements: We thank AstraZeneca for providing funding for this research project.

10%

2%

3%

12%

9%

16%

15%

24%

27%

30%

30%

25%

61%

51%

48%

30%

"Having diabetesincreases the risk of

heart disease."

"Taking steps todecrease risk of heartdisease can also help

your diabetes."

"Having an A1C of 7%or lower means less risk

of heart disease."

"I often think about myrisk of heart disease." 5%

3%

5%

5%

7%

25%

33%

24%

26%

27%

33%

27%

29%

42%

28%

42%

33%

Currently onSGLT-2 or GLP-1

Not on SGLT-2 or GLP-1

Currently onSGLT-2 or GLP-1

Not on SGLT-2 or GLP-1

Figure 2. Awareness (top) and interest (bottom) in cardioprotectivediabetes drugs, by current SGLT-2/GLP-1 usage. Respondents with T2D(n=927) were asked how much they agree or disagree with statementsregarding cardioprotective diabetes drugs on a scale of 1-10. Shown is thepercentage of respondents in each scale bucket, split by SGLT-2 or GLP-1usage (n=431) versus not (n=496).

Table 2. General or diabetes healthcare professionals seen and discussed CV risk with during the past year.

2%

6%

28%

27%

37%

31%

16%

29%

46%

24%

24%

22%

41%

82%

66%

54%

49%

48%

41%

28%

A1C

Blood pressure

Weight

LDL cholesterol

HDL cholesterol

Triglycerides

Resting heart rate

Don't know it at all Know it, but no goal Know it, have goal

31%

32%

37%

Seen a cardiologist in the past year

No cardiologist, but CV riskdiscussion with a different careproviderNo cardiologist nor CV risk discussionwith a care provider

% seen in past year(of total)

% discussed CVD risk(of total)

Primary care doctor 89% 46%

Endocrinologist 36% 17%

Nurse practitioner 29% 12%

Diabetes educator 11% 5%Nutritionist or

dietician 11% 4%

None of the above 3%

Figure 3. Knowledge of and goals for diabetes and CV metrics.Respondents with T2D (n=927) were asked how well they knew each of themetrics listed above. If they knew them (roughly or exactly), they were askedif they had a goal or target number agreed to with their doctor. Respondentswere classified based on knowledge and having a target for each metric,with the segment breakdown shown above.

Figure 5. CV risk information received from professionals in the pastyear. Respondents with T2D (n=927) were grouped based on the careprofessionals they had seen in the past year and whether or not they haddiscussed the risk of CVD with those professionals.

Not smoking or

using tobacco

Limiting alcohol intake

Getting regular health

screenings

Managing stress

Eating a healthy diet

Getting enoughquality sleep

Maintaining weight goal

or losing weight

Getting regular

exercise

4% 2% 3% 3%89%

1% 3% 9% 13%

74%

2% 5%27% 31% 35%

8% 19%41%

21% 11%

5%21%

45%24%

5% 8%28% 37%

17% 9%

16%31% 33%

14% 6%22% 34% 25% 13% 6%

Poor Below average Average Above average Great

Figure 4. Self-scorecards on CV risk reduction behaviors. Respondentswith T2D (n=927) were asked to give themselves a grade on the followingbehaviors, which are associated with decreased risk for CVD. Shown aboveare the full distributions of self-assigned scores, on a scale from Poor to Great.

INTERACTION WITH HEALTHCARE PROFESSIONALS

“Some diabetes drugs can also help protect you from heart disease.”

“I would take an additional diabetes drug if it also offered some protection from heart disease.”

Strongly disagree(1-2)

Disagree(3-4)

Neutral(5-6)

Agree(7-8)

Strongly agree(9-10)

Table 1. Baseline demographics and health characteristics of respondents.