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Closing the Cardio-Renal Preventive Treatment Gap Among Patients with Type 2 Diabetes Mellitus and Chronic Kidney Disease: An Implementation Science Approach

Award Number: R00HL157721
ORGANIZATION: NATIONAL HEART, LUNG, & BLOOD INSTITUTE
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
PERIOD OF PERFORMANCE START DATE: 02/01/2024
PERIOD OF PERFORMANCE END DATE: 01/31/2027

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Closing the Cardio-Renal Preventive Treatment Gap Among Patients with Type 2 Diabetes Mellitus and Chronic Kidney Disease: An Implementation Science Approach - Project Summary/Abstract 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.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2026 ( Subtotal = $236,314 )
2026	2026	REGENTS OF THE UNIVERSITY OF CALIFORNIA, SAN FRANCISCO, THE	1855 FOLSOM ST STE 425	SAN FRANCISCO	CA	94103	SAN FRANCISCO	USA	Cardiovascular Diseases Research	000	5	2/18/2026	NON-COMPETING CONTINUATION	$236,314
														Subtotal = $236,314

Issue Date FY: 2025 ( Subtotal = $248,723 )
2025	2025	REGENTS OF THE UNIVERSITY OF CALIFORNIA, SAN FRANCISCO, THE	1855 FOLSOM ST STE 425	SAN FRANCISCO	CA	94103	SAN FRANCISCO	USA	Cardiovascular Diseases Research	000	4	3/14/2025	NON-COMPETING CONTINUATION	$248,723
														Subtotal = $248,723

Issue Date FY: 2024 ( Subtotal = $247,068 )
2024	2024	REGENTS OF THE UNIVERSITY OF CALIFORNIA, SAN FRANCISCO, THE	1855 FOLSOM ST STE 425	SAN FRANCISCO	CA	94143	SAN FRANCISCO	USA	Translation and Implementation Science Research for Heart, Lung, Blood Diseases, and Sleep Disorders	000	3	1/25/2024	EXTENSION WITH OR WITHOUT FUNDS	$247,068
														Subtotal = $247,068

Grand Total All Awards = $732,105

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Closing the Cardio-Renal Preventive Treatment Gap Among Patients with Type 2 Diabetes Mellitus and Chronic Kidney Disease: An Implementation Science Approach

Award Number: R00HL157721

ORGANIZATION: NATIONAL HEART, LUNG, & BLOOD INSTITUTE

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

PERIOD OF PERFORMANCE START DATE: 02/01/2024

PERIOD OF PERFORMANCE END DATE: 01/31/2027

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