High-scoring endocrinologists are more likely to prescribe key diabetes drugs

Endocrinologists who scored highest on the American Board of Internal Medicine's Longitudinal Knowledge Assessment (LKA^®) were more likely to prescribe a key diabetes drug class following a treatment guidelines update compared to doctors with lower scores.

In 2019, the American Diabetes Association (ADA) updated its Standards of Care to encourage prescribing sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA) for adults with type 2 diabetes who are at high risk for cardiovascular disease, heart failure or chronic kidney disease. Researchers examined how endocrinologists' prescribing patterns for these patients changed before and after the update and whether those changes varied among high- and low-scoring LKA participants.

The study found:

• From 2018 (the year before the guideline update) to 2022, overall SGLT2i prescribing for patients with type 2 diabetes targeted by the updated recommendations increased by 11.4 percentage points compared with patients not targeted by the recommendations. This comparative increase was 2.4 percentage points for GLP-1RA prescribing.
• The increase in SGLT2i prescribing was more than 30% larger among patients treated by endocrinologists with high (top quartile) first-year LKA scores compared with those with low (bottom quartile) scores. These score differences were not associated with increases in GLP-1RA prescribing.

Rozalina McCoy, MD, MS, senior author, endocrinologist, Associate Professor of Medicine and Vice Chief of Clinical Research, division of Endocrinology, Diabetes and Nutrition, University of Maryland School of MedicineThese therapies can help prevent some of the most serious and costly cardiovascular and kidney complications of diabetes, including those that can lead to hospitalizations, disability and premature death. Yet even though they are widely recommended for high-risk patients, many who could benefit most from these drugs are not receiving them. Our findings about which physicians are most likely to prescribe these medications underscore the importance of continuous learning and staying current with emerging evidence to help ensure patients receive the best possible care."

The study analyzed Medicare claims data from 2017 through 2022 and included 1,061 endocrinologists caring for 177,284 Medicare beneficiaries with type 2 diabetes. Researchers compared prescribing patterns among patients targeted by the updated ADA treatment recommendations with those among patients not targeted and examined those patterns next to endocrinologists' subsequent first-year LKA performance.

The findings join other newly published research examining possible connections between LKA participation and patient care among endocrinologists, which found that 95% of doctors surveyed reported learning while answering LKA questions. Sixty-eight percent said they were motivated to study by the real-time feedback they received through those assessments, and 53% reported that LKA participation resulted in changes or planned changes to patient care, according to findings published in August in Journal of the Endocrine Society.

"Our findings demonstrate that high scores on an ABIM assessment signal that a physician has kept current with medical knowledge in their field," said lead author Bradley Gray, PhD, ABIM Principal Health Services Researcher. "Taken together, these studies suggest that continuing certification activity may play an important role in how quickly new evidence reaches patients and offer opportunities to better understand how physicians keep pace with advances in medicine."

Source:

American Board of Internal Medicine

Journal reference: