UW Cardiometabolic Project ECHO Pre-Survey

Please complete the pre-survey below.

Thank you!

Name:

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Phone number:

Contact Email:

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Check this box ONLY if you DO NOT want your answers to be used for research purposes.

Answers will NOT be reported individually.

I do not want my answers used for research

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What is your professional degree?

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DO/MD

Physician Assistant (PA)

Nurse Practitioner (NP)

PA Student

NP Student

Medical Student

Medical Resident

Pharmacist

Other

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Where do you currently practice medicine?

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How many years have you practiced medicine?

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Still in training

< 1 year

1-3 years

3-5 years

5-7 years

7-10 years

11-20 years

> 20 years

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Consider the last few months: On average, how many half-days of clinic do you work in a typical week?

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1-2 half-days

3-4 half-days

5-6 half-days

7-8 half-days

>8 half-days

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Consider the last few months: In a typical week, approximately how many patients do you see who have: Type 2 Diabetes, Cardiometabolic disease, Renal disease, and/or Obesity?

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1-5 patients

6-10 patients

11-15 patients

16-20 patients

>20 patients

>30 patients

> 50 patients

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What percent of your patients with diabetes (type 1 and type 2) in your clinic had a HbA1c value of > 9% during the past calendar year?

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Less than 5%

5-10%

Greater than 10-15%

Greater than 15-20%

Greater than 20-25%

Greater than 25-30%

Greater than 30-35%

Greater than 35-40%

Greater than 40-45%

Greater than 45-50%

Greater than 50%

I do not know

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Always

Sometimes

Rarely

Never

I have never heard of this medication

Basal insulin therapy

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Multi-dose insulin therapy

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Non-insulin injectable agents (glucagon-like peptide-1 (GLP-1) receptor agonists

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Sodium-glucose co-transporter-2 (SGLT2) inhibitors

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Metformin in patients with GFR < 60 but > 45

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Phentermine

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Topiramate

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Bupropion

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Naltrexone

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Finerenone

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Icosapent Ethyl

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Spironolactone

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Angiotensin II Receptor Blockers

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Neprilysin Inhibitor

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PCSK9-Inhibitor

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Always

Sometimes

Rarely

Never

Insulin-requiring diabetes

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Cardiometabolic disease

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Obesity/weight management

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Kidney disease

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Known coronary artery disease

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Not Competent

Vaguely Competent

Slightly Competent

Average amongst peers

Competent

Very Competent

Teach others

Collect a cardiometabolic focused health history

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Educate clinic staff about patients with obesity, diabetes, and cardiometabolic disease

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Give evidence-based nutritional advice

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Provide quality diabetes care

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Discuss complications related to diabetes and cardiometabolic disease, and how to avoid or delay them

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Demonstrate empathy toward patients with cardiometabolic disease

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Identify social barriers for my patients with cardiometabolic disease

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Provide appropriate interventions for overcoming social barriers for my patients

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Determine which diabetes patients are appropriate for insulin therapy

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Manage insulin in a patient with diabetes

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Identify contraindications to diabetes medications

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Identify depression using the PHQ-9 scale and to recommend evidence-based depression treatment

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Serve as a cardiometabolic disease resource for other providers in my community

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Not Confident at all

Not Confident

Somewhat not Confident

Neither Confident or not Confident

Somewhat Confident

Confident

Absolutely Confident

Managing patients with type 2 diabetes?

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Using the current Guidelines, American Diabetes Association (ADA) and American College of Cardiologists (ACC) in your current practice?

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Managing hypertension and cholesterol in patients with cardiovascular risk?

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Initiating anti-obesity agents?

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Helping patients achieve their diabetes care/self-management goals?

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Improvement in your quality metrics related to diabetes & cardiometabolic disease?

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For patients with type 2 diabetes, what HbA1c goal do you recommend?

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A) < 6.5%

B) < 7.0%

C) < 8.0%

D) Depends on patient characteristics

E) Other

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You are seeing a newly diagnosed 49-year-old female with type 2 diabetes and current HbA1c is 10.5%. She reports weight loss and polyuria. Her kidney function is normal.

In addition to lifestyle counseling, what is the next best step out of the choices provided?

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A) Start metformin only

B) Start glipizide only

C) Start metformin and glipizide

D) Start metformin and basal insulin

E) Start metformin and a GLP-1 receptor agonist

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How do you typically initiate basal insulin in a patient with type 2 diabetes?

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A) I never initiate basal insulin

B) I start at 10 units daily

C) I start a weight-based dose of 0.1-0.3 units/kilogram

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You are seeing a 55-year-old male with normal kidney function and BMI 33. Previously, he had sub-optimally managed his diabetes for 6 years. He had recent admission for stroke. He was discharged on metformin 500mg XR twice a day and glargine. His current HbA1c is 7.0%.

Select the BEST next step.

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A) Continue current therapy

B) Reduce insulin by 20% and increase metformin to 1000mg twice a day

C) Reduce insulin by 20% and add GLP-1 receptor agonist

D) Reduce insulin by 20% and add SGLT2 inhibitor

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Of the medications listed below, which classes of medications also have the Food and Drug Administration indication for cardiovascular disease benefit?

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A) Empagliflozin and sitagliptin (SGLT2I and DPP-4I)

B) Sitagliptin and metformin (DPP-4I and Biguanides)

C) Metformin and liraglutide (Biguanides and GLP-1RA)

D) Liraglutide and empagliflozin (GLP-1RA and SGLT2I)

E) Sitagliptin and liraglutide (DPP-4I and GLP-1RA)

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At what degree for renal insufficiency do you need to stop metformin 1,000 mg?

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A) Creatinine of 1.4 mg/dL in women and 1.5mg/dL in men

B) GFR < 45 mL/min / 1.73 m2

C) GFR < 30 mL/min / 1.73 m2

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Select the most correct statement for patients with Type 2 diabetes that are on pre-meal and basal insulin.

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A) Metformin should be discontinued or not started in those on multi-dose insulin

B) Metformin may be continued or started based on GFR but other insulin-sparing agents should never be considered

C) Other insulin-sparing agents should be considered but metformin should be stopped or not started

D) Metformin should be started or continued based on GFR and other insulin-sparing agents should be considered

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A 45-year-old male patient with Type 2 diabetes for 6 years, controlled hypertension, and obesity (BMI 32) presents for cardiovascular risk stratification after a second cousin died suddenly. He is taking Metformin 500 mg twice a day, Losartan 50 mg daily, and Co-Q10. HIs blood pressure is 122/69 mmHg, his lipid profile is: total cholesterol 189 mg/dL, HDL 41 mg/dL, and LDL 123 mg/dL. He is a non-smoker and has no first degree relatives with early heart disease. He is reluctant to take any new medications but is nervous about his health and willing to listen to your opinion.

In addition to lifestyle modification, which of the following is a correct best step?

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A) Start high intensity statin + aspirin 81 mg

B) Start high intensity statin + aspirin 325 mg

C) Start moderate intensity statin + aspirin 81 mg

D) Start moderate intensity statin ONLY

E) Order treadmill stress test to base treatment decision and to assess for silent myocardial ischemia

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Sodium-glucose cotransporter-2 (SGLT2) inhibitors should not be initiated in which of the following patients?

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A) Patient with Type 2 diabetes with recent kidney stones

B) Patient with diabetes and heart failure with preserved ejection fraction and history of pancreatitis

C) A patient with diabetes and history of coronary artery disease and unilateral renal artery stenosis with eGFR of 50 mL/min/1.74m2

D) A patient with fatty liver disease and an eGFR of 23 mL/min/1.74m2

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A 32-year-old female with Type 2 diabetes is seeing you for her initial routine wellness visit. Her BMI is 35 kg/m2. She is on metformin 2,000 mg per day and glipizide 5 mg. Her A1c is 6.8% and blood pressure is 158/86 mmHg. Her additional past medical history includes nephrolithiasis 6 months ago and gallstone induced pancreatitis. She has been doing weight watchers again for the third time in her life and is struggling to lose weight. She confides to you that she is hungry all the time! She asks your opinion on how she should lose weight.

You tell her...

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A) She should stick to weight watchers

B) She should exercise more and eat less

C) We should consider stopping the glipizide

D) She should try a ketogenic diet

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In the same patient as above, which medication would be the best choice for appetite suppression?

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A) Phentermine/Topiramate

B) Phentermine

C) Bupropion/Naltrexone

D) Fenfluramine/Phentermine

E) Semaglutide

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A 48-year-old woman with biopsy proven diabetic chronic kidney disease (CKD) returns for follow-up. Review of her relevant laboratories indicates a creatinine of 1.7 (eGFR 38 mL/min), potassium 4.6, A1c 6.4%, and urine protein to creatinine ratio (UPCR) of 1.6 mg/g on a spot collection. In-office blood pressure is 124/72 mmHg, congruent with home blood pressure monitoring. She is currently on therapy with Olmesartan 40 mg daily, Dapagliflozin 10 mg daily, Semaglutide 1 mg subcutaneously weekly, and Chlorthalidone 25 mg daily.

What is the BEST next step in medical management?

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A) Diltiazem

B) Pentoxifylline

C) Finerenone

D) Linagliptin

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A 54-year-old man with a history of Type 2 diabetes, stage G3bA2 chronic kidney disease and hypertension presents for follow-up. He has been scrolling through twitter and read something about new Kidney Disease: Improving Global Outcomes (KDIGO) blood pressure guidelines. He asks you what his target blood pressure should be.

You tell him his target blood pressure is...

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A) < 140/80 mmHg

B) < 130/80 mmHg

C) < 120/80 mmHg

D) < 150/80 mmHg

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A 66-year-old male with Type 2 diabetes and known coronary artery disease has a lipid profile that reveals triglycerides of 289 mg/dL and LDL-C of 58 mg/dL. He is treated with Rosuvastatin 40 mg daily. His diabetes is treated with metformin and Sodium-glucose cotransporter-2 (SGLT2) inhibitor. His most recent A1C is 6.7%.

The BEST next step for cardiovascular risk reduction in this individual is...

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A) Decrease rosuvastatin to 20 mg

B) Add ezetimibe

C) Add icosapent ethyl

D) No further therapy is needed at this time

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A 54-year-old woman with 10 years of Type 2 diabetes is noted to have mildly elevated liver enzymes. She drinks alcoholic beverages very rarely. BMI is 36 kg/m2. A1C is 6.9% with ALT 58 (7-40). Work up is negative for Hepatitis B and Hepatitis C, with normal iron studies. Ultrasound of the liver reveals "increased echogenicity of liver parenchyma consistent with hepatic steatosis".

Which of the following is the best next step in this patient?

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A) Perform vibration controlled transient elastography (Fibroscan)

B) Perform magnetic resonance elastography

C) Refer for liver biopsy

D) Start statin therapy

E) Start vitamin E

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In your experience, which of the following barriers most commonly prevents patients with cardiometabolic disease from reaching goal HbA1c, cholesterol, or blood pressure?

Check all that apply.

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A) Provider does not advance medication regimen

B) The patient is not motivated to reach therapeutic goals

C) Lack of team-based follow-up with patients between appointments

D) Short duration of appointment time

E) The patient does not show up for follow-up appointments

F) The patient is not following treatment plan with medications

G) The patient does not have access to medications

H) Poor exercise habits

I) Poor eating habits

J) Other (please explain below)

Other barriers. Please explain:

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Let's say you are able to make three changes to the way cardiometabolic disease care is provided at your health center.

Which THREE of the following changes would you prioritize?

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Provider access to advice from an endocrinologist through an e-consult service

Certified Diabetes Educator added to care team

Nutritionist added to care team

Clinical pharmacist added to care team

Personal trainer added to care team

Diabetes patient registry with protocols for team-based monitoring and follow-up

Regular team meetings to discuss challenging patients

All patients not at goal asked to collaborate in creating an individualized care plan

Patients not at goal are given longer appointment times, e.g. one half-hour

Patients not at goal are scheduled during a special "diabetes clinic" time during which the care team sees only patients with diabetes

Diabetes group visits

Other (please specify below)

Other changes. Please explain:

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