Individuals with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD) have an extremely high risk
of cardiovascular disease (CVD). However, they are not optimally prescribed evidence-based cardio-renal
preventive therapies that could considerably reduce such risk. These therapies, which include angiotensin-
converting enzyme inhibitors/angiotensin-receptor blockers (ACEI/ARB), glucagon-like peptide-1 receptor
agonists (GLP1) and sodium-glucose co-transporter 2 inhibitors (SGLT2i), substantially lower CVD risk and the
risk of CKD progression. Thus, their optimal prescription could lead to marked reductions in the CVD burden of
patients with T2DM and CKD.
In the mentored phase of the award, the proposed research will investigate the major factors
accounting for the under-prescription of cardio-renal preventive therapies among patients with T2DM and CKD.
To accomplish this, we will conduct mixed-methods research combining quantitative analyses with qualitative
explorations. Specifically, in Aim 1 we will leverage a dataset of over 1.5 million patients with T2DM in the
Veterans Affairs (VA) system to identify multi-level predictors of prescription of cardio-renal preventive
therapies. In Aim 2, we will conduct focus groups with patients and providers to qualitatively explore contextual
determinants of the under-prescription of cardio-renal preventive therapies.
In the independent phase of the award (Aim 3), we will leverage findings form Aims 1 and 2 to
implement an educational intervention aimed at improving primary care providers’ knowledge and self-efficacy
regarding cardio-renal preventive therapies in one medical facility. The components of the educational
intervention are: 1) an educational toolkit consisting of an informational booklet, fact sheets/infographics, and
informational posters for use in clinics; 2) primary care provider champions who will serve as reference
providers regarding prescription of cardio-renal preventive therapies; and 3) interdisciplinary case-conferences
regarding appropriate prescription of cardio-renal therapies. We will evaluate the change of primary care
providers’ knowledge and self-efficacy before and after the intervention and compare changes in the rates of
prescription of cardio-renal preventive therapies with a “passive” control medical facility.
The completion of the proposed research and training in implementation science and mixed-methods
research will be instrumental to establish Dr. Lamprea Montealegre’s independent research career at the
intersection of CVD epidemiology and implementation science. In particular, the new set of skills in
implementation science will allow Dr. Lamprea Montealegre to lead research and clinical programs on CVD
prevention through the systematic detection and treatment of CKD, and to become a national leader in
preventive cardio-renal care.