REVERSE: Reducing cardiovascular and kidney risk in diabetes

Background

Diabetes is a major public health challenge, causing additional complications across multiple organ systems. Cardiovascular disease (CVD) and chronic kidney disease (CKD) are the leading causes of disability and death in people with type 2 diabetes mellitus (T2DM).

In Australia, T2DM prevalence has nearly tripled in recent decades, with around 1.3 million people affected. The condition carries enormous economic and societal costs. T2DM has a major impact in socioeconomically disadvantaged areas like Western Sydney, South-Western Sydney, and regional NSW, where high prevalence and CVD/CKD complications represent major challenges for local health services.

Treatments to slow and prevent the CVD/CKD effects of diabetes exist, but they rely on a health system that can readily identify high-risk patients, implement, and monitor treatment, and coordinate the complex care of such patients. Although proven strategies to delay and prevent the impacts of CVD and CKD in high-risk diabetes patients exist (including newer medicines such as SGLT-2 inhibitor and GLP-1 antagonists), significant gaps and barriers hinder their adoption including the uptake of guideline recommended care. Existing systems, especially in underserved communities, do not adequately meet the needs of these patients, making robust development and testing of new care approaches vital.

Aim

REVERSE aims to co-design with stakeholders a suite of interventions centred on a cardiovascular nurse coordinator role to enhance care coordination for people with T2DM, who are at high risk of CVD and or CKD. re. The project will then evaluate the effectiveness of these interventions in reducing CVD and/or CKD risk.

Research Methodology

The REVERSE Trial will recruit general practices (GP) in South-Western Sydney that care for adult patients with T2DM who are at high risk of CVD or CKD. The project will consist of 3 phases: (1) feasibility phase, (2) intervention design phase, (3) pilot phase. The proposed intervention to be designed and tested is centred around a CV Nurse Co-ordinator role, aiming to improve diabetes care coordination by bridging gaps in health services between community primary care, secondary care, and tertiary care (if required) at specific time points of a patients’ journey. The intervention will be delivered at the practice level. Routinely collected de-identified data will be utilised.

Current Status

The Feasibility Study (Phase 1) and Process Mapping Study (Phase 2) have been approved by UNSW HREC. Three General Practices in South Western Sydney have successfully been enrolled, and qualitative data collection is in progress. The retrospective data analysis care of 240 practices servicing approximately 500,000 patients is in progress to understand the current burden of type 2 diabetes mellitus (T2DM) and patterns of care in primary care. This will inform the design of the study intervention which will aim to reduce gaps and variation in care.