Study Links Board Exam Scores to Diabetes Prescribing Rates

Board Scores Correlate With Adoption of Diabetes Drug Updates

Endocrinologists who scored in the top quartile of a board certification assessment adopted updated treatment guidelines for type 2 diabetes faster than their lower-scoring peers. The finding comes from an observational study published in JAMA Network Open by researchers from the American Board of Internal Medicine (ABIM) and the University of Maryland School of Medicine.

In 2019, the American Diabetes Association (ADA) updated its Standards of Care. The revision encouraged clinicians to prescribe sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA) for adults with type 2 diabetes who face elevated risks for cardiovascular disease, heart failure, or chronic kidney disease.

Prescribing Differences Appeared in SGLT2 Inhibitor Uptake

Researchers analyzed Medicare claims data from 2017 through 2022 covering 1,061 endocrinologists and 177,284 Medicare beneficiaries with type 2 diabetes. Overall prescribing of SGLT2 inhibitors for targeted high-risk patients rose by 11.4 percentage points relative to untargeted patients, while GLP-1 receptor agonist prescribing rose by 2.4 percentage points.

The increase in SGLT2 inhibitor prescribing was over 30% larger among patients whose endocrinologists achieved top-quartile scores on the ABIM Longitudinal Knowledge Assessment (LKA) relative to bottom-quartile scorers. Performance gaps on the assessment did not correlate with differences in GLP-1 receptor agonist prescribing.

Survey Links Real-Time Testing Feedback to Clinical Practice

Related survey research published in the Journal of the Endocrine Society evaluated how endocrinologists engage with the Longitudinal Knowledge Assessment. The assessment offers periodic questions with immediate feedback rather than a single ten-year examination.

The survey reported that 95% of participating endocrinologists said they learned while answering questions. In addition, 68% noted the real-time feedback motivated further study, and 53% reported making or planning actual clinical adjustments based on the process.

What the Research Means for High-Risk Diabetes Care

The observational findings indicate that clinical knowledge gaps may delay access to therapies that protect kidney and heart function. Senior author Rozalina McCoy noted that many patients who qualify for organ-protective medications still do not receive them.

Adults managing type 2 diabetes alongside cardiovascular or kidney risks can discuss current guideline-directed therapies with their physician. These discussions help verify whether organ-protective medication classes match an individual's specific complication profile.

Study Scope and Dataset Boundaries

The dataset relied exclusively on Medicare claims, meaning the findings reflect fee-for-service beneficiaries rather than younger adults or commercial insurance populations. Claims data track dispensed prescriptions, leaving out unmeasured factors like patient out-of-pocket costs, prior authorization hurdles, and drug shortages.

The study design cannot establish that testing caused higher prescribing rates. High test scores and proactive guideline adoption may both stem from an underlying tendency to read new literature promptly.