Almost HALF of Cardiovascular Disease in Diabetes NOT TREATED!!

This video provides an in-depth exploration of the alarming under-treatment of cardiovascular disease (CVD) in patients with diabetes, despite the availability of highly effective and affordable medications. Dr. Eric Bricker begins by outlining the pathophysiology of atherosclerosis, explaining how diabetes exacerbates the hardening and narrowing of arteries, leading to critical conditions such as heart attacks, strokes, and peripheral vascular disease (PVD). He emphasizes that PVD, often affecting the feet, can result in non-healing ulcers, gangrene, and amputations, while strokes are essentially "heart attacks of the brain" caused by similar atherosclerotic processes. The speaker highlights that this disease is "silent," meaning patients often feel fine until a catastrophic event occurs, making proactive treatment crucial.

The presentation then details three categories of evidence-based treatments for diabetic patients with atherosclerosis: statin medications (e.g., Lipitor, Crestor) for cholesterol lowering, ACE inhibitors or Angiotensin Receptor Blockers (ARBs) for blood pressure control and organ protection (heart, blood vessels, kidneys), and newer medications like SGLT2 inhibitors and GLP-1 receptor antagonists that improve outcomes. The core issue is revealed through a study published in the Journal of the American Medical Association (JAMA) in February 2022. This study, encompassing hundreds of thousands of patients across 12 hospital systems, found that a staggering 43% of individuals with diabetes and cardiovascular disease received zero evidence-based treatments. Furthermore, only 20% received both statins and ACE inhibitors/ARBs, despite these being generic, "dirt cheap," and available for decades.

Dr. Bricker critically examines the reasons behind this significant "gap in evidence-based care." He argues that the problem is not a lack of medical discovery but a profound failure in implementation within the American healthcare system. He points out that the fee-for-service payment model offers no accountability for doctors to follow evidence-based guidelines. Even existing value-based payment programs, including commercial and Medicare initiatives, are failing to move the needle on these statistics. Given that diabetes prevalence is growing (from 8% to 13% of adults in America over 20 years), this under-treatment represents a massive and escalating problem. The speaker concludes by asserting that employers, who bear the financial risk for their employees' health plans, must "own this problem" of implementation, as it is solvable and directly impacts their financial burden and employee well-being.

Key Takeaways:

• Widespread Under-treatment: A JAMA study revealed that 43% of patients with diabetes and cardiovascular disease receive no evidence-based treatments, and only 20% receive the two well-established, affordable treatments (statins and ACE inhibitors/ARBs).
• Pathophysiology of Atherosclerosis: Diabetes significantly worsens atherosclerosis (hardening and narrowing of arteries) by making cholesterol plaques "extra sticky," while hypertension increases the likelihood of these plaques rupturing, leading to severe blockages.
• Consequences of Untreated Atherosclerosis: This silent disease can lead to heart attacks, strokes, peripheral vascular disease (causing non-healing foot wounds, gangrene, and amputations), and kidney failure requiring dialysis.
• Effective and Affordable Treatments Exist: Established treatments like statins (cholesterol-lowering) and ACE inhibitors/ARBs (blood pressure and organ protection) have been available for over two decades, are generic, and are "dirt cheap," often costing just a few dollars a month. Newer medications like SGLT2 inhibitors and GLP-1 receptor antagonists also improve outcomes.
• "Gaps in Evidence-Based Care": This medical jargon refers to the failure to implement known, effective treatments that prevent severe cardiovascular events and complications in diabetic patients.
• Implementation Problem, Not Discovery Problem: The core issue is not a lack of scientific discovery or effective medications, but rather a systemic failure in the healthcare infrastructure to ensure these proven treatments are consistently applied to patients who need them.
• Failure of Current Payment Systems: The fee-for-service model provides no accountability for physicians to adhere to evidence-based guidelines. Critically, even existing value-based payment programs in commercial insurance and Medicare are not effectively addressing these treatment gaps.
• Growing Public Health Crisis: The prevalence of diabetes in American adults has increased significantly (from 8% to 13% in 20 years), exacerbating the impact of this under-treatment problem on individuals and the healthcare system.
• Employers Bear Financial Risk: Employers sponsoring health plans are ultimately responsible for the financial burden of poor patient care and preventable complications arising from untreated cardiovascular disease in their diabetic employees.
• Call to Action for Employers: Employers are urged to "own this problem" of implementation, as it is solvable and crucial for reducing their financial risk and improving the health of their plan members.
• Physician Engagement is Key: The study found that 75% of these under-treated patients had been seen by a primary care physician or cardiologist, indicating that the issue often lies with physician adherence to guidelines or patient engagement strategies.

Tools/Resources Mentioned:

• Journal of the American Medical Association (JAMA) - cited study from February 17, 2022.
• CDC National Diabetes Statistics Report - referenced for diabetes prevalence data.

Key Concepts:

• Atherosclerosis: A disease in which plaque builds up inside your arteries, causing them to harden and narrow, restricting blood flow.
• Peripheral Vascular Disease (PVD): A circulatory condition in which narrowed blood vessels reduce blood flow to the limbs, often leading to non-healing wounds, ulcers, and potential amputation.
• Statins: A class of drugs used to lower cholesterol levels in the blood.
• ACE Inhibitors (Angiotensin-Converting Enzyme Inhibitors) / ARBs (Angiotensin Receptor Blockers): Medications primarily used to treat high blood pressure and heart failure, also protective for the heart, blood vessels, and kidneys.
• SGLT2 Inhibitors / GLP-1 Receptor Antagonists: Newer classes of medications for diabetes that have also shown significant cardiovascular and renal benefits.
• Evidence-Based Care: Medical care that is supported by clinical research and scientific evidence.
• Fee-for-Service: A payment model where healthcare providers are paid for each service they provide.
• Value-Based Payment: A payment model that rewards healthcare providers for quality of care and patient outcomes, rather than quantity of services.