· Executive Brief
National Diabetes Heart Connection Day 2026
Move from recognition activity to a visible operating route with named owners and closed loops.
Leadership signal
Use National Diabetes Heart Connection Day to examine the system behind the message.
Leaders can use this window to test whether public information, service entry points, internal referrals, and follow-up responsibilities form one understandable route. The review should start with the experience of people using the system and the teams responsible for receiving them.
Start by distinguishing what is known from what the organization still needs to learn. A campaign plan, communication volume, or meeting count does not establish that a route is usable. Leaders need direct listening, clear ownership, locally defined measures, and a method for keeping exceptions visible.
Executive opening
Diabetes and heart care share one patient but rarely one pathway
Diabetes and heart disease are usually managed by different teams, budgets and schedules, yet the people living with both move through one health system. The therapies that protect the heart in diabetes are well established, but they reach a minority of eligible patients. A meta-analysis of 102 real-world studies found a pooled global prevalence of SGLT2 inhibitor use of 12%, and 13% among patients with cardiovascular disease.[1] For executives, that gap is less a prescribing question than an operating one.
In a large U.S. tertiary referral center, 22% of adults with type 2 diabetes and atherosclerotic cardiovascular disease received SGLT2 inhibitor prescriptions, and 25.3% received GLP-1 receptor agonist prescriptions.[7] In England, 18 months after a national guideline update, 19.5% of people with type 2 diabetes and cardiovascular disease had a current SGLT2 inhibitor prescription.[5] These figures come from different settings and are not directly comparable. Together they show the same pattern: recommended therapy exists, but the route to it is unreliable.
The gaps also fall unevenly. In England, uptake was lower among people aged over 60, women, Black people and people living in more deprived areas.[5] In U.S. survey data, adults with type 2 diabetes and incomes above the median were more likely to use semaglutide, with an odds ratio of 1.61.[15] Those patterns point to access, coverage, ownership and trust, which sit squarely within executive responsibility.
National Diabetes Heart Connection Day is a useful moment to ask whether the organization runs cardiometabolic care as one pathway or as several unconnected ones. The sections below summarize peer-reviewed evidence on therapy gaps, heart failure risk, team-based models, transitions, access, equity, workforce and communication. They add a factual base to the executive guidance already on this page without prescribing clinical decisions for any individual.
Current evidence
What the research says about therapy gaps and heart risk
The case for connecting diabetes and heart care rests on large real-world studies. A Danish nationwide cohort followed people with type 2 diabetes and established cardiovascular disease.[10] Compared with using neither drug class, combining a cardioprotective glucose-lowering drug with a statin was associated with a hazard ratio of 0.71 for a new major adverse cardiovascular event.[10] The corresponding hazard ratios were 0.82 for the glucose-lowering drug alone and 0.85 for a statin alone.[10] The authors cautioned that this design cannot support causal interpretation, and they described real-world uptake of both drug classes as persistently suboptimal.[10]
Heart failure risk is a second reason to connect the two services. In U.K. primary care data on 57,368 SGLT2 inhibitor initiators and 111,673 comparator initiators, SGLT2 inhibitor use was associated with a 30% lower risk of new-onset heart failure.[8] Relative heart failure benefit did not vary by baseline absolute heart failure risk.[8] The same team built a prediction model to estimate individual five-year heart failure benefit for people without atherosclerotic disease, heart failure or chronic kidney disease.[8] For health systems, the implication is that targeting depends on reliable risk data rather than a single visit or a single specialist.
Statin gaps are just as visible. At an integrated U.S. health system, only 43.2% of 266 adults aged 40 to 75 with type 1 diabetes were prescribed a guideline-recommended statin.[11] Among those with a history of atherosclerotic disease, 39.3% received a high-intensity statin.[11] Overall, 47.7% of these patients achieved the latest LDL cholesterol targets.[11] In a separate study of 210 patients with type 2 diabetes, only 90 (42.9%) were statin users, with a 12.2% adherence rate.[13]
Prevention decisions also depend on how risk is assessed. One U.S. national survey sample was weighted to represent 115.7 million adults aged 40 to 75 without known atherosclerotic disease.[12] In that sample, 77% had at least one risk-enhancing factor and 28% had at least three.[12] The most common were elevated high-sensitivity C-reactive protein at 49.6% and metabolic syndrome at 48.3%.[12] Any risk-enhancing factor was associated with 2.17 greater odds of statin use, yet the authors found these factors were inconsistently associated with prescribing.[12] Measurement choices therefore shape who is offered prevention long before a cardiovascular event occurs.
Figure 1
Guideline cardiometabolic therapy reaches a minority of eligible patients
Percent of patients using or prescribed the therapy, as reported in each study. Values are copied from the cited studies [1], [5], [7], [11]; none is estimated.
Data note. These values come from different studies, countries, years, populations and definitions of use, so this is an indirect comparison; the bars show how far each setting is from full use, not how one therapy compares with another.
Limitation. Each value reflects its own denominator; the global figure pools heterogeneous studies, and the statin figure concerns type 1 rather than type 2 diabetes.
Figure data (5 rows)
| Measure | Value | Population, setting and year as reported | Source |
|---|---|---|---|
| Pooled global SGLT2 inhibitor use | 12% | Meta-analysis of 102 real-world studies of patients with type 2 diabetes, chronic kidney disease or cardiovascular disease | [1] |
| Current SGLT2 inhibitor prescription, type 2 diabetes with cardiovascular disease | 19.5% | People with type 2 diabetes and cardiovascular disease only, England, 1 September 2023 | [5] |
| SGLT2 inhibitor prescription, type 2 diabetes with ASCVD | 22% | 8096 adults at a U.S. tertiary referral center, records from June 2016 to August 2023 | [7] |
| GLP-1 receptor agonist prescription, type 2 diabetes with ASCVD | 25.3% | Same 8096 adults at a U.S. tertiary referral center | [7] |
| Guideline-recommended statin prescribed, type 1 diabetes aged 40 to 75 | 43.2% | 266 adults at a U.S. integrated health system, 2020 to 2024 | [11] |
Continuum of care
Where the cardiometabolic pathway breaks between teams
The clearest sign of a broken handoff is when each clinician assumes another will act. In the type 1 diabetes study, the most common documented barrier to statin therapy was deferral to another healthcare professional, at 23.3%.[11] Statin intolerance followed at 15.8%, and clinical inertia at 9.0%.[11] Deferral is an ownership problem more than a knowledge problem. It appears when endocrinology, cardiology and primary care each see part of the patient but no one holds the cardiovascular prevention task. Each service may document a sound plan, yet the patient leaves without a decision. The fix is an explicit assignment of who decides, who acts and who confirms that the action happened.
Team-based models are designed to remove that ambiguity. The Cardiometabolic Center Alliance enrolled 2,223 patients with type 2 diabetes or prediabetes, cardiovascular disease and chronic kidney disease across 9 U.S. sites between May 2020 and August 2024.[2] The program used team care, structured visits and standardized assessments.[2] Over a median follow-up of 6.8 months, participants had reductions in weight, blood pressure, cholesterol, fasting glucose and HbA1c, and the authors reported increased use of guideline-directed medical therapy.[2] Because the design was a prospective cohort, the results describe change within the program rather than a randomized comparison.
Starting a therapy is only the first transition, and staying on it is the second. In a Japanese hospital-based cohort of 1,925 adults starting a first biguanide or SGLT2 inhibitor, persistence at 48 weeks was 56.2% for SGLT2 inhibitors in the first-line cohort.[14] In the second-line cohort, persistence at 48 weeks was 49.4% for SGLT2 inhibitors and 51.8% for biguanides.[14] When about half of patients are no longer on therapy at 48 weeks, follow-through becomes a pathway measure rather than a pharmacy detail.[14]
Structured follow-up has been tested as one response. In the 210-patient type 2 diabetes study, patients received education, statin initiation, changes in type or dose, added therapy or adherence support, and were reevaluated three months later.[13] At the first visit, only 6.6% and 7.7% of statin users had reached LDL and non-HDL targets.[13] At the second visit, 64.3% of all included patients reached the LDL target and 57.6% reached the non-HDL target.[13] The pre-post design cannot separate the intervention from other changes, but it shows that a scheduled return visit is a controllable step. Leaders can decide whether such a return contact is built into the pathway or left to individual memory and scheduling luck.
Figure 3
Why the pathway breaks
People
- Deferral to another clinician leaves prevention unowned
- Pharmacist roles not scoped to cardioprotective therapy
- Clinical inertia when other measures look controlled
Process
- No structured return visit after initiation
- No route for reported side-effect concerns
- Separate diabetes and cardiology workflows
Technology
- Risk data not used to target therapy
- No shared registry across services
- Persistence not tracked after the first prescription
Environment
- Rural clinics with limited specialist access
- Lower uptake in more deprived areas
- Specialist contact concentrated in some settings
Policy
- Coverage and cost barriers for newer agents
- Payment models that do not recognize pharmacist services
- Trial eligibility criteria that exclude some populations
Measurement
- Uptake not stratified by sex, ethnicity, income or deprivation
- Risk-enhancing factors applied inconsistently
- No review of guideline uptake after updates
Unranked qualitative cause-and-effect diagram for the outcome in the box: People with diabetes and cardiovascular disease or risk do not start, receive or stay on guideline cardioprotective therapy Causes are assembled from the cited literature [1], [3], [4], [5], [8], [9], [11], [12], [14], [15]; categories are not weighted and their order carries no meaning.
Data note. Qualitative; no frequencies are implied.
Limitation. Causes drawn from published studies may not all apply locally; validate them with frontline teams.
Figure data (6 rows)
| Category | Causes drawn from the cited literature |
|---|---|
| People | Deferral to another clinician leaves prevention unowned; Pharmacist roles not scoped to cardioprotective therapy; Clinical inertia when other measures look controlled |
| Process | No structured return visit after initiation; No route for reported side-effect concerns; Separate diabetes and cardiology workflows |
| Technology | Risk data not used to target therapy; No shared registry across services; Persistence not tracked after the first prescription |
| Environment | Rural clinics with limited specialist access; Lower uptake in more deprived areas; Specialist contact concentrated in some settings |
| Policy | Coverage and cost barriers for newer agents; Payment models that do not recognize pharmacist services; Trial eligibility criteria that exclude some populations |
| Measurement | Uptake not stratified by sex, ethnicity, income or deprivation; Risk-enhancing factors applied inconsistently; No review of guideline uptake after updates |
Access
Access to guideline therapy depends on coverage, setting and specialty
Access to cardiometabolic therapy varies by setting, insurance and specialty contact. In the global meta-analysis, SGLT2 inhibitor prescribing was significantly related to age, sex, body mass index, Medicare and endocrinology visits.[1] Use was higher among patients enrolled after December 2020 than among those enrolled before, at 20% versus 9%.[1] Adoption is rising, but it still depends on which door a patient enters.
Insurance shows the same pattern inside a single health system. At the U.S. tertiary center, 8096 of 791,873 adults seen in outpatient settings met criteria for type 2 diabetes with atherosclerotic cardiovascular disease.[7] Patients prescribed SGLT2 inhibitors and those prescribed GLP-1 receptor agonists were both more likely to be privately insured.[7] After adjustment, men were more likely to be prescribed SGLT2 inhibitors, and women were more likely to be prescribed GLP-1 receptor agonists for secondary prevention overall.[7]
Cost is a direct access barrier. One study used 2022 national survey data on 2542 U.S. adults with type 2 diabetes, representing about 30.3 million adults.[15] Private insurance was associated with greater semaglutide use, with an odds ratio of 1.52.[15] Education level and employment status were also significant predictors of access.[15] The authors pointed to expanded coverage, subsidy programs and pricing strategies as potential policy responses.[15] For health systems, affordability belongs in pathway design alongside referral and scheduling.
National utilization data can show the pace of adoption over time. In Croatia, SGLT2 inhibitor use rose from 0.49 to 11.63 defined daily doses per 1000 inhabitants per day between 2014 and 2024.[6] Even so, SGLT2 inhibitor monotherapy accounted for just 12% of non-insulin antidiabetic prescriptions in 2024.[6] The authors called for targeted educational and policy efforts to overcome therapeutic inertia.[6] Steady growth at the national level can still leave large local gaps, which is why each organization needs its own view of access.
Geography and setting add another layer. The authors of the rural pharmacist study describe Rural Health Clinics as playing a critical role in addressing diabetes in medically underserved areas.[3] The family medicine study focused on a medically underserved population with baseline HbA1c above 9%.[9] In both settings, the entry point for many patients is primary care rather than a cardiology or endocrinology clinic. Access planning should therefore ask whether cardioprotective therapy can start where patients already receive care, instead of waiting for a referral that may not happen.
Executive guidance · System route
Connect the day to an accountable system route.
Use this route as a discussion framework. Replace each stage with the organization’s approved process, qualified roles, current service capacity, and applicable requirements. Do not infer a clinical protocol from the observance title.
The route at a glance
- Listen
- Clarify entry
- Connect the recovery route
- Protect transitions
- Verify and learn
Reliability rule: Every stage needs a named owner, an observable status, an approved escalation path, and a defined signal that shows whether responsibility moved or remained unresolved.
Listen
Gather questions and friction points from people using the route, frontline teams, and community-facing staff. Separate observed barriers from assumptions.
Clarify entry
Publish a plain-language first step and identify who receives requests through each approved channel.
Connect the recovery route
Where locally relevant, make transitions among information, evaluation, services, recovery support, and follow-through visible without prescribing a clinical pathway.
Protect transitions
Use acknowledgment and status visibility when responsibility moves between services, locations, or organizations.
Verify and learn
Review unresolved work, repeat contacts, and avoidable handoffs. Use the findings to improve the route rather than blame individuals.
Figure 2
The system route as one flow
The five stages of the system route described in this brief, drawn as one flow with a learning loop back to the start. The stages are the page’s original executive guidance, not a clinical protocol.
Data note. Shows sequence and handoffs only; it carries no counts or rates.
Limitation. Local processes may add, merge or reorder stages under organizational policy.
Figure data (5 rows)
| Stage | What the stage requires |
|---|---|
| Listen | Gather questions and friction points from people using the route, frontline teams, and community-facing staff. Separate observed barriers from assumptions. |
| Clarify entry | Publish a plain-language first step and identify who receives requests through each approved channel. |
| Connect the recovery route | Where locally relevant, make transitions among information, evaluation, services, recovery support, and follow-through visible without prescribing a clinical pathway. |
| Protect transitions | Use acknowledgment and status visibility when responsibility moves between services, locations, or organizations. |
| Verify and learn | Review unresolved work, repeat contacts, and avoidable handoffs. Use the findings to improve the route rather than blame individuals. |
Equity and trust
Who is left out of the diabetes and heart connection
Equity gaps appear even under a single national guideline. The English study followed a cohort of 587,826 people with type 2 diabetes.[5] In adjusted models, SGLT2 inhibitor uptake was lower in people aged over 60, women, Black people and people living in areas of higher deprivation.[5] Uptake was also lower for people with cardiovascular disease alone, at 19.5%, than for people with heart failure alone, at 29.4%.[5] The authors stated that action is needed to address inequalities by ethnicity and deprivation.[5]
Evidence gaps can begin before a therapy reaches practice. A review of 352 registered GLP-1 receptor agonist trials found body mass index criteria in 233 trials (66.2%).[4] Where trials required a body mass index of at least 30 kg/m2, estimated eligibility was 41.5% for non-Asian U.S. adults.[4] It was 13.5% for Asian U.S. adults and 7.2% for Korean adults.[4] By contrast, HbA1c, kidney function and liver function criteria showed minimal differences between populations.[4] Evidence built on narrow eligibility criteria may not describe every community a health system serves.
Representation also matters inside care models. In the Cardiometabolic Center Alliance cohort, 84.0% of participants were White and 62.5% were noncommercially insured.[2] At the U.S. tertiary center, the authors reported notable prescribing disparities by gender, race and socioeconomic status.[7] Equity review therefore needs local stratified data rather than national averages alone.
Sex differences recur across settings. Among adults with type 1 diabetes, female sex was independently associated with lower odds of receiving guideline-recommended statin therapy, with an adjusted odds ratio of 0.45.[11] In U.S. survey data, racial and ethnic differences in semaglutide use were observed but did not reach statistical significance after adjustment.[15] Trust work should examine both the measured gaps and the experiences behind them, including how patients learn about therapy, cost and follow-up.
Equity measurement also needs the right comparison groups. In England, uptake was higher in people with more comorbidities in age-stratified analyses.[5] That pattern can mask gaps for people whose risk is real but less visible in the record. Health systems can stratify cardioprotective therapy use by sex, race, ethnicity, language, insurance, income and neighborhood, then review the results with community partners. Pairing data with listening helps leaders distinguish a coverage problem from a trust problem, and each calls for a different response.
Human infrastructure
Pharmacists, teams and the people who close cardiometabolic gaps
Workforce design determines who can act on a care gap. Two Centers for Medicare & Medicaid Services-designated Rural Health Clinics implemented a collaborative pharmacist care model for diabetes.[3] Among 93 patients cared for over a median of 247 days, mean A1C decreased from 9.3% to 7.7%.[3] The authors also reported increased use of guideline-directed medication therapy for diabetes and cardiometabolic comorbidities, and called for financial models that recognize the value of pharmacist services.[3]
A family medicine clinic serving a medically underserved population compared pharmacist-driven management under a collaborative practice agreement with usual care.[9] Among 126 included patients with a baseline HbA1c above 9%, mean HbA1c fell by 2.61% in the pharmacist group compared with 1.87% with usual care.[9] Basal insulin prescribing was higher in the pharmacist group, at 55% versus 33%, while low use of GLP-1 agonists and SGLT2 inhibitors was noted in both groups.[9] Adding a role does not close a cardioprotective gap unless the role is explicitly scoped to it.
Specialist and support capacity is part of the same picture. In the type 1 diabetes study, very few patients received adjunctive lipid-lowering agents, with ezetimibe at 4.1% and PCSK9 inhibitors at 0.4%.[11] The authors called for better care coordination, healthcare professional education and wider use of adjunctive therapies.[11] In the global meta-analysis, endocrinology visits were among the factors significantly related to SGLT2 inhibitor prescribing.[1] Where specialist contact drives access, specialist capacity becomes an equity issue.
For executives, the operating questions concern scope, authority and capacity. Leaders need to know which roles may initiate or adjust therapy under protocol, who reviews cardiovascular risk during a diabetes visit, and how pharmacist time is funded. The Cardiometabolic Center Alliance model paired team care with structured visits and standardized assessments across sites.[2] Its design suggests that workforce changes work best when they come with shared processes rather than as isolated hires.
Workload and training belong in the same review. Pharmacists, nurses, educators and navigators can only act on cardiometabolic gaps if their caseloads leave time for outreach and follow-up. Leaders should ask how new team members are trained on cardiovascular risk, who supervises protocol-based changes and how escalation works when a patient needs a physician decision. These questions turn a staffing plan into reliable human infrastructure that patients and clinicians can depend on.
Executive guidance · Operating dashboard
Review reliability, not campaign activity alone.
Do not publish a number until the organization defines its numerator, denominator where relevant, owner, source system, exclusions, review cadence, and limits. The candidates below are management prompts, not benchmarks or reported results.
Four operating signals
Each signal pairs an executive question with one candidate local measure, set out below.
Executive guidance · Signal
Entry-point clarity
Can people and staff identify the approved first step without searching across conflicting instructions?
- Candidate local measure
- Locally defined contact, routing, and repeat-contact signals by channel and service.
Executive guidance · Signal
Ownership reliability
Does a specific team accept each request and make its status visible?
- Candidate local measure
- Requests without an owner, aged work, transfers, and escalations using locally approved definitions.
Executive guidance · Signal
Recovery-route ownership
Where locally applicable, can people and teams identify the next owner across services and recovery support?
- Candidate local measure
- Locally defined transition acceptance, missing information, unresolved routes, repeat contacts, and experience feedback.
Executive guidance · Signal
Improvement closure
Does the organization correct recurring friction and report what changed?
- Candidate local measure
- Selected barriers, assigned actions, completion status, and post-change review.
Figure 4
The operating system behind the dashboard
The four operating signals from this brief’s dashboard, each tied to the candidate owner named in the executive scorecard, around one accountable route. Drawn from the page’s original executive guidance.
Data note. Structural diagram; no measured values.
Limitation. Owners are candidates to be confirmed locally.
Figure data (4 rows)
| Operating signal | Candidate owner |
|---|---|
| Entry-point clarity | Executive sponsor and operational lead |
| Ownership reliability | Operational owner and participating teams |
| Recovery-route ownership | Sending and receiving owners |
| Improvement closure | Improvement owner and executive sponsor |
Executive guidance · Handoff workflow
Transfer responsibility with acknowledgment and visibility.
A handoff is reliable only when the sending party knows who is expected to receive the work, the receiving party acknowledges responsibility, and any unresolved exception remains visible. Local policy and qualified judgment control the actual process.
How responsibility moves
Lane A
From message to accepted ownership
- Confirm the approved message and intended audience.
- Publish the actual entry point and receiving role.
- Acknowledge receipt using the locally approved method.
- Escalate when ownership or response remains unclear.
Lane B
From accepted ownership to verified follow-through
- Record the next accountable owner and visible status.
- Confirm the receiving owner and next contact across services or recovery support where locally applicable.
- Keep unresolved work visible across boundaries.
- Confirm closure or document the continuing exception.
Executive guidance · Executive scorecard
Connect operating signals to accountable executive review.
The scorecard keeps review focused on decisions. Leaders should set definitions locally, examine variation without overclaiming cause, and pair quantitative signals with the experience of people who use and operate the route.
Who reviews what
- Executive sponsor and operational lead
- Operational owner and participating teams
- Sending and receiving owners
- Improvement owner and executive sponsor
Candidate owners named in the scorecard, confirmed locally.
| Operating signal | Executive question | Candidate owner | Suggested review point |
|---|---|---|---|
| Entry-point clarity | Can people and staff identify the approved first step without searching across conflicting instructions? | Executive sponsor and operational lead | At campaign launch and close |
| Ownership reliability | Does a specific team accept each request and make its status visible? | Operational owner and participating teams | At a locally defined cadence |
| Recovery-route ownership | Where locally applicable, can people and teams identify the next owner across services and recovery support? | Sending and receiving owners | At a locally defined cadence |
| Improvement closure | Does the organization correct recurring friction and report what changed? | Improvement owner and executive sponsor | Until action is verified |
Figure 5
Control points for a reliable diabetes and heart pathway
| Control point | Risk if missing | Owner | Evidence of control |
|---|---|---|---|
| Named owner for cardiovascular prevention in every diabetes care plan | Each service defers to another and therapy is never started | Medical director for primary care with cardiology and endocrinology leads | Share of eligible patients with a documented owner and decision |
| Protocol-based pharmacist role for cardiometabolic therapy | Added capacity improves glucose but not cardioprotective therapy use | Pharmacy director | Approved scope, funded time and therapy-gap reviews completed |
| Scheduled return contact after therapy initiation | Patients stop therapy without anyone noticing | Ambulatory operations lead | Persistence and follow-up completion reviewed on a set cadence |
| Affordability and coverage check at the point of prescribing | Therapy prescribed but never filled or continued | Revenue cycle and pharmacy leaders | Documented cost barriers and resolution status |
| Stratified equity review of uptake | Gaps by sex, ethnicity, income or deprivation stay hidden | Chief health equity officer or quality lead | Uptake reported by group with actions assigned |
| Governed use of risk and benefit tools | Inconsistent targeting and unclear explanation to patients | Chief medical information officer | Approved tool list, training and documentation standard |
Control points derived from the cited evidence [2], [3], [5], [8], [9], [11], [14], [15] and this brief’s executive guidance.
Data note. Each row is a control to verify, not a measured result.
Limitation. Owners and evidence of control must follow local policy and applicable requirements.
Public communication
Communicating a connection people can trust and act on
Public messages about diabetes and heart health help only when the next step is real. The research on this page shows that many gaps sit inside the system rather than with patients. Deferral to another clinician was the most common documented barrier to statin therapy in one integrated health system.[11] Income and insurance shaped semaglutide use in national survey data.[15] Messaging that ignores those barriers can widen the distance between awareness and care. Before a campaign launches, leaders can test whether the advertised entry point connects people with a team able to review cardiovascular risk and act on it.
Clear explanation of benefit can support shared decisions. The SABRE model combines absolute heart failure risk with a hazard ratio of 0.63 for heart failure hospitalization, drawn from a trial meta-analysis, to estimate individual five-year benefit.[8] The authors describe it as an easily deployed prediction model that allows more precise targeting of SGLT2 inhibitors for primary heart failure prevention.[8] Any such tool needs governance over who uses it, how results are explained and how decisions are documented.
Communication with clinicians matters as much as communication with the public. The global meta-analysis concluded that variations across patient subgroups require addressing identified barriers to ensure optimal prescribing.[1] The Croatian authors called for targeted educational efforts to overcome therapeutic inertia.[6] Internal messages can share local uptake data with care teams, explain who owns each step and invite frontline staff to name the barriers they see. That approach treats clinicians as partners in redesign rather than as targets of reminders.
Concerns about side effects deserve a route, not a dead end. Statin intolerance was the second most common documented barrier in the type 1 diabetes study, at 15.8%.[11] Organizations can make sure that a reported concern is recorded, routed to a responsible clinician and revisited, rather than quietly closing the pathway. Staff communication should make that route visible without offering clinical advice outside qualified roles.
Public accountability is the final communication task. The English evaluation measured guideline uptake 18 months after publication and stratified results by age, gender, ethnicity and deprivation.[5] That approach gives boards and communities a factual account of progress and gaps. Health systems can apply the same discipline locally by reporting what changed after the observance, which groups still face barriers and who owns the next correction.
Executive guidance · 90-day plan
Use 90 days to correct one visible operating barrier.
The time boxes below are a management framework, not a clinical timeline. Adjust them to risk, scope, governance, resources, stakeholder participation, and applicable review requirements.
Ninety days, three moves
- Days 1–30See the current route
- Days 31–60Build the reliable path
- Days 61–90Make the change visible
Days 1–30 · Listen and map
See the current route
- Name an executive sponsor and an operational owner.
- Listen to people using the route and representative frontline teams.
- Map how National Diabetes Heart Connection Day communications connect to real entry points, owners, transitions, and escalation.
- Select one recurring barrier that the organization can responsibly address.
Days 31–60 · Design and test
Build the reliable path
- Define the trigger, receiving owner, required information, acknowledgment, escalation, and closure signal.
- Validate the design with every sending and receiving team involved.
- Review one locally relevant service-to-recovery handoff and verify that ownership remains visible.
- Test the route in more than one representative setting or operating period where practical.
Days 61–90 · Implement and verify
Make the change visible
- Launch the redesigned route with a small set of locally defined measures.
- Review unresolved work and recurring friction using a learning approach.
- Correct implementation barriers and record who owns each remaining dependency.
- Report what changed, what evidence was reviewed, and what still requires live oversight.
Figure 6
The 90-day plan on one timeline
The 90-day plan from this brief drawn as a timeline: each action sits in the 30-day window the plan assigns it. The full wording of each action is in the figure data and in the plan above.
Data note. Time boxes are a management framework, not a clinical timeline.
Limitation. Durations are uniform 30-day windows; real tasks may span windows.
Figure data (12 rows)
| Window | Action |
|---|---|
| Days 1–30 · Listen and map | Name an executive sponsor and an operational owner. |
| Days 1–30 · Listen and map | Listen to people using the route and representative frontline teams. |
| Days 1–30 · Listen and map | Map how National Diabetes Heart Connection Day communications connect to real entry points, owners, transitions, and escalation. |
| Days 1–30 · Listen and map | Select one recurring barrier that the organization can responsibly address. |
| Days 31–60 · Design and test | Define the trigger, receiving owner, required information, acknowledgment, escalation, and closure signal. |
| Days 31–60 · Design and test | Validate the design with every sending and receiving team involved. |
| Days 31–60 · Design and test | Review one locally relevant service-to-recovery handoff and verify that ownership remains visible. |
| Days 31–60 · Design and test | Test the route in more than one representative setting or operating period where practical. |
| Days 61–90 · Implement and verify | Launch the redesigned route with a small set of locally defined measures. |
| Days 61–90 · Implement and verify | Review unresolved work and recurring friction using a learning approach. |
| Days 61–90 · Implement and verify | Correct implementation barriers and record who owns each remaining dependency. |
| Days 61–90 · Implement and verify | Report what changed, what evidence was reviewed, and what still requires live oversight. |
Executive guidance · Leadership close
Pair recognition with a system people can trust.
Recognition matters. It becomes durable when leaders also listen, clarify the route, support the people operating it, close an identified gap, and report the result without claiming more than the evidence supports.
Leadership commitment
Connect the message to one usable, measured, and sustained operating change.
Executive action kit · Day observance
Turn National Diabetes Heart Connection Day into accountable action.
Move from recognition activity to a visible operating route with named owners and closed loops.
Leadership focus
Use this observance to examine navigation, longitudinal ownership, and specialty-care coordination. Select one verified barrier, assign an accountable owner, and carry the improvement beyond the campaign window.
Workforce lens
Ask whether staffing, role clarity, training, tools, workload, and escalation support the people operating the information, acute-to-ambulatory transition, rehabilitation, and follow-through pathway.
Patient and community lens
Make the approved first step clear. Test whether a person can move from information to an acknowledged next action without navigating conflicting instructions.
Equity and access lens
Review transportation, language, digital access, affordability, geography, disability, and whether the recovery route works across different settings.
Five-minute briefing
Inspect the operating sequence
Listen with patients, caregivers, cardiovascular teams, rehabilitation, pharmacy, and ambulatory partners. Find one an unowned transition, unclear recovery route, or unresolved access need, then test the locally approved route from entry through acknowledged follow-through.
- Listen
- Clarify entry
- Connect the recovery route
- Protect transitions
- Verify and learn
Leadership actions for this week
- Name an executive sponsor and frontline operating owner.
- Ask people using and operating the pathway where ownership becomes unclear.
- Test one representative route from first question to acknowledged next step.
- Select one barrier that can be corrected without overstating the evidence.
- Set a review date and define how completion will be verified.
Candidate measures
Define every numerator, denominator where relevant, owner, data source, exclusions, cadence, and limitation locally. These are management prompts, not external benchmarks.
- Locally defined contact, routing, and repeat-contact signals by channel and service.
- Requests without an owner, aged work, transfers, and escalations using locally approved definitions.
- Locally defined transition acceptance, missing information, unresolved routes, repeat contacts, and experience feedback.
Department readiness checklist
- The public and staff entry points match the actual approved process.
- A specific role accepts each request, referral, or escalation.
- Handoffs include acknowledgment and a visible unresolved state.
- Language, disability, digital, transportation, and trust barriers receive explicit review.
- Communications do not introduce unsupported themes, statistics, or clinical advice.
- A named leader will review what changed after the observance.
Intended audiences
- Executive and Operational Leaders
- Patient Experience and Access Leaders
Staff communication template
During National Diabetes Heart Connection Day, our organization will connect awareness with a practical review of the information, acute-to-ambulatory transition, rehabilitation, and follow-through pathway. Use approved information, identify the correct entry point, confirm ownership when work moves, protect privacy, and escalate unresolved barriers through local channels.
Community communication template
National Diabetes Heart Connection Day is an opportunity to share trustworthy information and make the next step easier to find. Use our approved channels for information and support. If a request changes hands, our goal is to keep ownership and follow-through visible.
Measurement worksheet
- Signal
- What observable condition will show whether the route works?
- Definition
- What is included, excluded, and counted?
- Owner
- Who reviews the signal and acts on exceptions?
- Cadence
- When will leaders review it?
- Equity check
- Which differences require protected, locally appropriate review?
- Closure
- What evidence will confirm the improvement was completed?
- Editorial review
- Completed
- Source records
- 2 listed under Authoritative resources
- Review standard
- Sourced facts remain separated from original executive guidance
- Clinical boundary
- No new statistical or clinical claim was added by this action kit
Sources and content boundary
Authoritative resources
- Observance source: diabetesheartconnection.org
- 2026 healthcare observances calendar: healthgrades.com
Use note: All operating models, measures, scorecard questions, and action steps are original executive guidance. This article supports leadership planning and education. It does not replace clinical judgment, emergency procedures, legal advice, professional standards, organizational policy, or applicable federal, state, and local requirements.
Peer-reviewed references
References
Fifteen peer-reviewed sources, newest first. Each was individually verified through authenticated academic research databases. Bracketed numbers in the text link here; the original executive guidance on this page carries no citations because it is guidance, not a sourced claim. Sources last checked in those databases on .
- 1.Xu M, Li Q, Chen N, Zhang X, Zhang W. Prescription Patterns and Associated Factors of Sodium-Glucose Cotransporter 2 (SGLT2) Inhibitors Use Among Patients Worldwide: A Systematic Review and Meta-Analysis of Real-World Studies. Journal of the American Medical Directors Association. 2026;27(2):106036. https://doi.org/10.1016/j.jamda.2025.106036
- 2.Neeland IJ, Magwire ML, Kwun A, Aistrope DS, Andaya EAK, Bashall A, et al. Optimizing Care in Cardiovascular-Kidney-Metabolic Syndrome: Registry Data From the Cardiometabolic Center Alliance. Circulation: Cardiovascular Quality and Outcomes. 2026;19(7). https://doi.org/10.1161/circoutcomes.125.012828
- 3.Wheeler SE, Lennon A, Switzer D. Impact of Pharmacist-Managed Diabetes Care on Clinical Outcomes in Rural Health Clinics. Annals of Pharmacotherapy. 2026:10600280261446051. https://doi.org/10.1177/10600280261446051
- 4.Huh KY, Song I. Fixed BMI eligibility criteria for GLP-1 receptor agonist trials and estimated trial-eligible proportions in Asian and non-Asian populations: A cross-sectional analysis. PLOS ONE. 2026;21(6):e0351415. https://doi.org/10.1371/journal.pone.0351415
- 5.Muller P, Wray J, Rahman M, Hawkins J, Bakhai C, Cuthbertson DJ, et al. SGLT2 Inhibitor Use in Type 2 Diabetes in England: A Population‐Based Cross‐Sectional Study of Uptake of NICE Guidance. Diabetes, Obesity and Metabolism. 2026;28(10):9573-9583. https://doi.org/10.1111/dom.71010
- 6.Belančić A, Kučan Štiglić M, Jelaković A, Pećin I, Jelaković B, Vitezić D. Utilization Trends of SGLT2 Inhibitors in Croatian Clinical Practice: Observational Analysis. Medicina. 2026;62(2):286. https://doi.org/10.3390/medicina62020286
- 7.Avenatti E, Sadhu A, Gullapelli R, Rao A, Pavuluri C, Nasir K, et al. Real-world prescribing patterns of SGLT2 inhibitors and GLP-1 receptor agonists in Type 2 diabetes with various ASCVD subtypes from a large tertiary referral center. American Journal of Preventive Cardiology. 2026;30:101733. https://doi.org/10.1016/j.ajpc.2026.101733
- 8.Young KG, McGovern AP, Hopkins R, Jansz TT, Cardoso PM, Holman RR, et al. Precision Prescribing of SGLT2 Inhibitors in Individuals With Type 2 Diabetes for Primary Prevention of Heart Failure: Model Development and Validation Study. Diabetes Care. 2026;49(6):1115-1123. https://doi.org/10.2337/dc25-2973
- 9.Chow A, Walter J. Comparison of Type 2 Diabetes Mellitus Management by an Ambulatory Care Pharmacist vs Usual Care in a Medically Underserved Population. Journal of Pharmacy Practice. 2026:08971900261450730. https://doi.org/10.1177/08971900261450730
- 10.Ternhamar T, Johansen MØ, Nordestgaard BG, Afzal S. Cardioprotective glucose-lowering drugs, statins, and secondary major adverse cardiovascular events: a nationwide cohort study of individuals with type 2 diabetes and cardiovascular disease. Cardiovascular Diabetology. 2026;25(1):254. https://doi.org/10.1186/s12933-026-03242-9
- 11.Lundholm MD. Statin prescription rates for prevention of atherosclerotic cardiovascular disease in adults 40–75 years old with type 1 diabetes. BMJ Open. 2026;16(3):e112682. https://doi.org/10.1136/bmjopen-2025-112682
- 12.Wilson LM, Sussman JB, Blumenthal RS, Reynolds HR, Anderson TS. Prevalence of Atherosclerotic Cardiovascular Disease Risk-Enhancing Factors and Their Association with Primary Prevention Statin Use. Journal of General Internal Medicine. 2026;41(12):3499-3507. https://doi.org/10.1007/s11606-026-10423-5
- 13.Abdelaal AM, Ghonem M, Mohamed YA, Hasan AS, Kyrillos F. Statin prescription patterns among patients with type 2 diabetes mellitus for primary and secondary prevention of cardiovascular disease. BMC Endocrine Disorders. 2026;26(1):106. https://doi.org/10.1186/s12902-026-02242-w
- 14.Mishima R, Koide D. Treatment Selection Patterns and Associated Outcomes for Biguanides and SGLT2 Inhibitors in Type 2 Diabetes: A Retrospective Database Study in Japan. Drugs – Real World Outcomes. 2026;13(3):395-408. https://doi.org/10.1007/s40801-026-00567-5
- 15.Vaidya V, Estep S, Gupte R. Income disparities and accessibility to Semaglutide: implications for diabetes management and policy reform. International Journal for Quality in Health Care. 2025;38(1):mzaf131. https://doi.org/10.1093/intqhc/mzaf131
Claim-to-source matrix
What each source supports
Every sourced claim in the new sections maps to the references that support it, the section where it is used, and the limitation a reader should keep in mind. Original executive guidance carries no sources because it is guidance, not a finding.
| Claim group | Sources | Years | Used in | Limitation |
|---|---|---|---|---|
| Low real-world use of SGLT2 inhibitors and GLP-1 receptor agonists in diabetes with cardiovascular disease | [1] [5] [6] [7] | 2026 | Executive opening | Different countries, years, data sources and definitions of use; values are not directly comparable. |
| Association of combined cardioprotective therapy and statins with fewer cardiovascular events | [10] | 2026 | Current evidence | Observational registry analysis; the authors state causal interpretation is not possible. |
| Heart failure risk and targeting of SGLT2 inhibitors | [8] | 2026 | Current evidence | U.K. primary care data from 2013 to 2020; prediction model applies to people without existing ASCVD, heart failure or kidney disease. |
| Statin prescribing gaps and documented barriers including deferral | [11] [12] [13] | 2026 | Current evidence | Single-system and single-study samples; barriers taken from physician documentation; cross-sectional designs. |
| Team-based and structured follow-up models | [2] [13] | 2026 | Continuum of care | Prospective cohort and pre-post designs without randomized comparison; short follow-up. |
| Persistence on therapy after initiation | [14] | 2026 | Continuum of care | Japanese hospital-based records; intention-to-treat persistence; may not generalize to U.S. settings. |
| Access shaped by insurance, income and specialty contact | [1] [7] [15] | 2026, 2025 | Access | Cross-sectional associations; survey data cannot capture prescribing decisions directly. |
| Inequities by sex, ethnicity, deprivation and trial eligibility | [4] [5] [7] [11] [15] | 2026, 2025 | Equity and trust | Trial eligibility estimates are modeled from survey data; some racial differences were not significant after adjustment. |
| Pharmacist-led diabetes care in rural and underserved settings | [3] [9] | 2026 | Human infrastructure | Small retrospective single- or two-site studies; outcomes focus on glycemic control rather than cardiovascular events. |
About the author
Greg Wahlstrom
MBAHCM
President and Chief Executive Officer, The Healthcare Executive
View Greg’s profile©2014 – 2026 The Healthcare Executive. All rights reserved.