Age, Renal Dysfunction, Cardiovascular Disease, and Antihyperglycemic Treatment in Type 2 Diabetes Mellitus: Findings from the Renal Insufficiency and Cardiovascular Events Italian Multicenter Study

2013 ◽  
Vol 61 (8) ◽  
pp. 1253-1261 ◽  
Author(s):  
Anna Solini ◽  
Giuseppe Penno ◽  
Enzo Bonora ◽  
Cecilia Fondelli ◽  
Emanuela Orsi ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Type 2 Diabetes Mellitus ◽  
Renal Insufficiency ◽  
Renal Dysfunction ◽  
Multicenter Study ◽  
Cardiovascular Events

Impact of Cardiovascular Screening Tests in Patients with Type 2 Diabetes Mellitus without Previous Histories of Cardiovascular Disease: 5-year Clinical Outcomes.

2020 ◽  
Author(s):  
Yoshibumi Antoku ◽  
Masao Takemoto ◽  
Takahiro Mito ◽  
Ryuta Shiiyama ◽  
Hiroko Otsuka-Morisaki ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Type 2 Diabetes Mellitus ◽  
Clinical Outcomes ◽  
Cardiovascular Events ◽  
Screening Tests ◽  
Cardiovascular Screening ◽  
History Of

Abstract Background We previously reported that, among the asymptomatic patients with type 2 diabetes mellitus (T2DM) without history of cardiovascular disease (CVD), up to 19% of the patients with myocardial ischemia were detected by cardiovascular screening tests (CVSTs). We concluded that the CVSTs in patients with T2DM may be one of the most effective strategies to find CVD in those patients. Thus, the aim of the study was to assess the long-term clinical outcomes of CVSTs in patients with T2DM without previous histories of CVD. Methods Six hundred fifty-seven out-patients with T2DM who received CVSTs at least more than one time or not at all from April in 2014 to March in 2019 were defined as the S group or NS group, respectively. The data in 2104 and 2018 were collected from the medical records, and compared between the S and NS groups. Results This study revealed that, in the out-patients with T2DM in our hospital over those 5 years; 1) the frequency of receiving CVSTs was significantly increasing, 2) in accordance with that increase, the frequency of the internal use for CVD of statins, anti-platelets, and renin-angiotensin system inhibitors, which are well-known as medications for preventing CVD, was significantly increasing, 3) however, there was only a small increase in the internal use of sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptors, which are well-known to suppress cardiovascular events in patients with T2DM, 4) LDL-cholesterol and triglycerides significantly improved more in the S group than the NS group, 5) highly sensitive C-protein, which is one of the strongest predictors of CVD, was significantly suppressed by CVSTs, 6) the progression of renal dysfunction was significantly more suppressed in the S group than the NS group, 7) in an inverse proportion to the CVST increase, the frequency of acute coronary syndrome, cerebral infarctions, 4-point major adverse cardiovascular events, and admissions due to heart failure were significantly decreasing, and 8) finally, the frequency of all-cause mortality was significantly suppressed during those 5 years. Conclusions Thus, it may be important to continue CVSTs in out-patients with T2DM without a previous history of CVD for several years.

Mechanisms of Protective Effects of SGLT2 Inhibitors in Cardiovascular Disease and Renal Dysfunction

2019 ◽  
Vol 19 (20) ◽  
pp. 1818-1849 ◽  
Author(s):  
Ban Liu ◽  
Yuliang Wang ◽  
Yangyang Zhang ◽  
Biao Yan
Keyword(s):  
Diabetes Mellitus ◽  
Heart Failure ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Renal Dysfunction ◽  
Sglt2 Inhibitors ◽  
Sodium Glucose Cotransporter ◽  
Glucose Reabsorption ◽  
Renal Glucose Reabsorption

: Type 2 diabetes mellitus is one of the most common forms of the disease worldwide. Hyperglycemia and insulin resistance play key roles in type 2 diabetes mellitus. Renal glucose reabsorption is an essential feature in glycaemic control. Kidneys filter 160 g of glucose daily in healthy subjects under euglycaemic conditions. The expanding epidemic of diabetes leads to a prevalence of diabetes-related cardiovascular disorders, in particular, heart failure and renal dysfunction. Cellular glucose uptake is a fundamental process for homeostasis, growth, and metabolism. In humans, three families of glucose transporters have been identified, including the glucose facilitators GLUTs, the sodium-glucose cotransporter SGLTs, and the recently identified SWEETs. Structures of the major isoforms of all three families were studied. Sodium-glucose cotransporter (SGLT2) provides most of the capacity for renal glucose reabsorption in the early proximal tubule. A number of cardiovascular outcome trials in patients with type 2 diabetes have been studied with SGLT2 inhibitors reducing cardiovascular morbidity and mortality. : The current review article summarises these aspects and discusses possible mechanisms with SGLT2 inhibitors in protecting heart failure and renal dysfunction in diabetic patients. Through glucosuria, SGLT2 inhibitors reduce body weight and body fat, and shift substrate utilisation from carbohydrates to lipids and, possibly, ketone bodies. These pleiotropic effects of SGLT2 inhibitors are likely to have contributed to the results of the EMPA-REG OUTCOME trial in which the SGLT2 inhibitor, empagliflozin, slowed down the progression of chronic kidney disease and reduced major adverse cardiovascular events in high-risk individuals with type 2 diabetes. This review discusses the role of SGLT2 in the physiology and pathophysiology of renal glucose reabsorption and outlines the unexpected logic of inhibiting SGLT2 in the diabetic kidney.

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