Higher Medical Knowledge Scores Linked to Faster Uptake of Recommended Diabetes Drugs

Endocrinologists who scored highest on the American Board of Internal Medicine’s Longitudinal Knowledge Assessment were more likely to prescribe a key class of diabetes drugs after a major guideline update, compared with colleagues who scored lower on the same quarterly assessment.

The guideline change in question came in 2019, when the American Diabetes Association updated its Standards of Care to encourage prescribing sodium-glucose cotransporter-2 inhibitors (SGLT2 inhibitors) and glucagon-like peptide-1 receptor agonists (GLP-1 receptor agonists) for adults with type 2 diabetes who are at high risk for cardiovascular disease, heart failure or chronic kidney disease.

To measure how prescribing changed, researchers analyzed Medicare claims data from 2017 through 2022, covering 1,061 endocrinologists who cared for 177,284 Medicare beneficiaries with type 2 diabetes. They compared prescribing patterns among patients targeted by the updated recommendations with patterns among patients not targeted, and then examined whether those changes varied according to each endocrinologist's subsequent first-year performance on the LKA, ABIM's Longitudinal Knowledge Assessment.

The overall shift was substantial. From 2018, the year before the guideline update, to 2022, SGLT2 inhibitor prescribing for patients targeted by the updated recommendations increased by 11.4 percentage points relative to patients not targeted by the recommendations. The comparative increase for GLP-1 receptor agonist prescribing was smaller, at 2.4 percentage points.

The knowledge score connection emerged clearly for one of the two drug classes. The increase in SGLT2 inhibitor prescribing was more than 30% larger among patients treated by endocrinologists in the top quartile of first-year LKA scores than among those treated by physicians in the bottom quartile. Notably, the score differences were not associated with increases in GLP-1 receptor agonist prescribing, suggesting the relationship between assessed knowledge and guideline adoption may depend on the specific therapy and clinical context.

Senior author Rozalina McCoy, MD, MS, an endocrinologist and Associate Professor of Medicine at the University of Maryland School of Medicine, emphasized the stakes of the gap the study documented. “These therapies can help prevent some of the most serious and costly cardiovascular and kidney complications of diabetes, including those that can lead to hospitalizations, disability and premature death,” she said. “Yet even though they are widely recommended for high-risk patients, many who could benefit most from these drugs are not receiving them.” She added that the findings underscore the importance of continuous learning and staying current with emerging evidence to help ensure patients receive the best possible care.

The study joins other newly published research examining possible connections between LKA participation and patient care among endocrinologists. In findings published in August in the Journal of the Endocrine Society, 95% of doctors surveyed reported learning while answering LKA questions, 68% said they were motivated to study by the real-time feedback the assessments provide, and 53% reported that LKA participation resulted in changes or planned changes to patient care.

Lead author Bradley Gray, PhD, ABIM Principal Health Services Researcher, framed the results as a signal about what assessment scores actually measure. “Our findings demonstrate that high scores on an ABIM assessment signal that a physician has kept current with medical knowledge in their field,” he said. “Taken together, these studies suggest that continuing certification activity may play an important role in how quickly new evidence reaches patients and offer opportunities to better understand how physicians keep pace with advances in medicine.”

Several caveats are worth keeping in view. The research is observational, so it shows an association between assessment performance and prescribing change rather than proving that high scores cause faster adoption. The study population was limited to Medicare beneficiaries and endocrinologists, leaving open how the pattern might extend to other specialties, younger patients or different insurance populations. McCoy reported unrelated research support from the NIH, PCORI and the American Diabetes Association, along with consulting and speaking relationships, and no other disclosures were reported.

Even with those limitations, the work addresses a persistent problem in modern medicine: the lag between guideline recommendations and clinical practice. Cardiovascular and kidney complications of diabetes remain among the disease’s most serious and costly consequences, and the drugs highlighted in the 2019 update are widely recommended for the highest-risk patients yet remain underused. By linking a standardized, ongoing measure of medical knowledge to real-world prescribing shifts in a large Medicare cohort, the study suggests that keeping physicians current may be measurable, and that the speed at which new evidence changes care may depend in part on how actively clinicians engage with that evidence.

Subject of Research: The association between endocrinologists' medical knowledge assessment scores and prescribing of guideline-recommended diabetes drugs after a 2019 guideline update

Article Title: Endocrinologists who demonstrate greater medical knowledge more likely to prescribe a recommended treatment for patients with type 2 diabetes

Article References: Endocrinologists who demonstrate greater medical knowledge more likely to prescribe a recommended treatment for patients with type 2 diabetes. Original publication (Bibliographic details unavailable.)

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Keywords: type 2 diabetes, endocrinology, SGLT2 inhibitors, GLP-1 receptor agonists, clinical guidelines, ABIM, Longitudinal Knowledge Assessment, Medicare, prescribing patterns, continuing medical education, cardiovascular risk, chronic kidney disease