The Diabetes Staging System in Patient Aligned Care Teams
Trial Parameters
Brief Summary
The purpose of this study is to examine the feasibility/acceptability of the Diabetes Staging System (DSS) in Patient Aligned Care Teams (PACT) teams and its ability to increase sodium-glucose cotransporter-2 inhibitor (SGLT2i) and glucagon-like-1 peptide (GLP-1) use in Veteran patients with type 2 diabetes and cardiovascular disease and/or chronic kidney disease.
Eligibility Criteria
Inclusion Criteria: * male or female * prior history of cardiovascular disease (myocardial infraction, cardiac stents, coronary artery pass, diastolic/systolic heart failure, stroke, carotid endarterectomy, femoral popliteal bypass, abdominal aortic aneurysm) * prior history of chronic kidney disease (GFR \<60, microalbumin creatinine/ratio \>30 mg/g - creatinine on 3 separate occasions) * age 25-75 years * BMI \>27 * diagnosis of type 2 diabetes * hemoglobin A1C \>7.0% * agreeable to regular visits per study protocol * access to telephone and reliable transportation and has an assigned PACT provider using a Freestyle Libre 2 or Freestyle lite glucometer to monitor blood sugars or willing to monitor blood sugars during study Exclusion Criteria: * age \>75, * A1C \<7% * GFR \<30 * pregnant * breast feeding * prior history of pancreatitis will lead to avoidance of GLP-1 agonist therapy but not SGLT2i * prior history of gastroparesis, dysphagia will lead to avoidance of GLP-1 agonist ther