Optimizing Cardiovascular Care and Promoting Excellent Health Outcomes for Adults with Diabetes across settings

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality for the more than 530 million adults with type 2 diabetes (hereafter diabetes) worldwide. Moreover, diabetes is increasingly recognized as a major public health threat worldwide: for instance, as of 2021, over 90 million adults in India, Mexico, and similar settings were estimated to have diabetes. Recognizing this, the World Health Organization (WHO) and national governments have newly committed to the Global Diabetes Compact targets, which aim to ensure that 80% of people with diagnosed diabetes achieve glycemic and blood pressure control, and 60% receive a statin. However, investments in the diabetes care continuum required to achieve these targets remain inadequate, in part because the health benefits and cost-effectiveness of these investments have not been clearly demonstrated. The primary objective of this application is to assess the impact of improving CVD care for adults with diagnosed diabetes in these diverse global settings on clinical outcomes, cost-effectiveness, and health equity. This project is led by Dr. Jennifer Manne-Goehler, an accomplished Early-Stage Investigator with expertise in global diabetes, and an interdisciplinary team of experts in microsimulation modeling and global CVD epidemiology, including: Drs. Kenneth Freedberg, Mark Siedner and Oyere Onuma from Massachusetts General Hospital, Pooyan Kazemian from Case Western University, and David Flood from University of Michigan. In this proposal, we will first develop the PREDICT-DM Global simulation model of CVD in adults with diabetes and populate it with empiric data from across several high-prevalence settings, leveraging a previously validated pilot model. Next, we will use the model to evaluate the clinical impact, costs, and cost-effectiveness of strategies to scale-up established therapies for glycemia, blood pressure, and lipids on CVD outcomes for adults with diagnosed diabetes in each of these countries under different scenarios. Third, we will investigate the clinical impact, costs, cost-effectiveness, and equity implications of introducing novel therapies such as glucagon-like peptide-1 receptor agonists (GLP-1 RA) and sodium-glucose cotransporter-2 inhibitors (SGLT2i) on CVD outcomes in these same populations. By bringing together an outstanding, experienced, interdisciplinary team, we will create a highly adaptable and durable platform for developing and informing strategies to strengthen comprehensive CVD care and improve CVD outcomes for adults with diabetes globally over the next decade.