scholarly journals Prescribing Paradigm Shift? Applying the 2019 European Society of Cardiology–Led Guidelines on Diabetes, Prediabetes, and Cardiovascular Disease to Assess Eligibility for Sodium–Glucose Cotransporter 2 Inhibitors or Glucagon-Like Peptide 1 Receptor Agonists as First-Line Monotherapy (or Add-on to Metformin Monotherapy) in Type 2 Diabetes in Scotland

Diabetes Care ◽  
2020 ◽  
Vol 43 (9) ◽  
pp. 2034-2041 ◽  
Author(s):  
Thomas M. Caparrotta ◽  
Luke A.K. Blackbourn ◽  
Stuart J. McGurnaghan ◽  
John Chalmers ◽  
Robert Lindsay ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Paradigm Shift ◽  
First Line ◽  
Sodium Glucose Cotransporter ◽  
Metformin Monotherapy ◽  
Glucagon Like Peptide ◽  
Glucagon Like Peptide 1 ◽  
European Society Of Cardiology

scholarly journals Prescribing paradigm shift? Applying the 2019 European Society of Cardiology-led guidelines on ‘diabetes, pre-diabetes, and cardiovascular disease’ to assess eligibility for sodium-glucose co-transporter-2 inhibitors or glucagon-like peptide-1 receptor agonists as first-line monotherapy (or add-on to metformin monotherapy) in type 2 diabetes in Scotland

2020 ◽  
Author(s):  
Caparrotta Thomas M ◽  
Blackbourn Luke AK ◽  
McGurnaghan Stuart J ◽  
Chalmers John ◽  
Lindsay Robert ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
High Risk ◽  
European Society ◽  
Metformin Monotherapy ◽  
Drug Naïve ◽  
Glucagon Like Peptide ◽  
Glucagon Like Peptide 1 ◽  
European Society Of Cardiology

Objective: In 2019, the European Society of Cardiology led and released new guidelines for diabetes’ cardiovascular risk management, reflecting recent evidence of cardiovascular disease (CVD) reduction with sodium-glucose co-transporter-2 inhibitors (SGLT-2i) and some glucagon-like peptide-1 receptor agonists (GLP1RA) in type 2 diabetes (T2D). A key recommendation is that all those with T2D who are (anti-hyperglycaemic) drug-naïve or on metformin monotherapy should be CVD-risk-stratified and an SGLT-2i or GLP1RA initiated in all those at high or very high risk, irrespective of glycated haemoglobin. We assessed the impact of these guidelines in Scotland were they introduced as is. <p>Research Design and Methods: Using a nationwide diabetes register in Scotland, we did a cross-sectional analysis, employing variables in our register for risk stratification at 1 January 2019. We were conservative in our definitions, assuming the absence of a risk factor where data were not available. The risk classifications were applied to those drug-naïve or metformin monotherapy people and the anticipated prescribing change calculated. </p> <p>Results: Of the 265,774 people with T2D in Scotland, 53,194 (20.0% of T2D) were drug-naïve and 56,906 (21.4%) were on metformin monotherapy. Of these, 74.5% and 72.4% respectively were estimated as at least high risk given the guideline risk definitions. </p> <p>Conclusion: Thus, 80,830 (30.4%) of <i>all</i> those with T2D (n=265,774) would start one of these drug classes according to table 7 and figure 3 of the guideline. The sizeable impact on drug budgets, enhanced clinical monitoring and the trade-off with reduced CVD-related healthcare costs will need careful consideration. </p>

scholarly journals Prescribing paradigm shift? Applying the 2019 European Society of Cardiology-led guidelines on ‘diabetes, pre-diabetes, and cardiovascular disease’ to assess eligibility for sodium-glucose co-transporter-2 inhibitors or glucagon-like peptide-1 receptor agonists as first-line monotherapy (or add-on to metformin monotherapy) in type 2 diabetes in Scotland

2020 ◽  
Author(s):  
Caparrotta Thomas M ◽  
Blackbourn Luke AK ◽  
McGurnaghan Stuart J ◽  
Chalmers John ◽  
Lindsay Robert ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
High Risk ◽  
European Society ◽  
Metformin Monotherapy ◽  
Drug Naïve ◽  
Glucagon Like Peptide ◽  
Glucagon Like Peptide 1 ◽  
European Society Of Cardiology

Objective: In 2019, the European Society of Cardiology led and released new guidelines for diabetes’ cardiovascular risk management, reflecting recent evidence of cardiovascular disease (CVD) reduction with sodium-glucose co-transporter-2 inhibitors (SGLT-2i) and some glucagon-like peptide-1 receptor agonists (GLP1RA) in type 2 diabetes (T2D). A key recommendation is that all those with T2D who are (anti-hyperglycaemic) drug-naïve or on metformin monotherapy should be CVD-risk-stratified and an SGLT-2i or GLP1RA initiated in all those at high or very high risk, irrespective of glycated haemoglobin. We assessed the impact of these guidelines in Scotland were they introduced as is. <p>Research Design and Methods: Using a nationwide diabetes register in Scotland, we did a cross-sectional analysis, employing variables in our register for risk stratification at 1 January 2019. We were conservative in our definitions, assuming the absence of a risk factor where data were not available. The risk classifications were applied to those drug-naïve or metformin monotherapy people and the anticipated prescribing change calculated. </p> <p>Results: Of the 265,774 people with T2D in Scotland, 53,194 (20.0% of T2D) were drug-naïve and 56,906 (21.4%) were on metformin monotherapy. Of these, 74.5% and 72.4% respectively were estimated as at least high risk given the guideline risk definitions. </p> <p>Conclusion: Thus, 80,830 (30.4%) of <i>all</i> those with T2D (n=265,774) would start one of these drug classes according to table 7 and figure 3 of the guideline. The sizeable impact on drug budgets, enhanced clinical monitoring and the trade-off with reduced CVD-related healthcare costs will need careful consideration. </p>

The Use of SGLT2i and GLP-1 RA in Patients with Type 2 Diabetes in Thailand: Evidence Review and Recommendations

2021 ◽  
Vol 104 (11) ◽  
pp. 1850-1865
Keyword(s):  
Type 2 Diabetes ◽  
Glucose Lowering ◽  
Sodium Glucose Cotransporter ◽  
Evidence Review ◽  
Glucagon Like Peptide ◽  
Glucagon Like Peptide 1 ◽  
Glucose Lowering Therapy ◽  
The Cost ◽  
Selection Of

Background: Cardiovascular (CV) and renal comorbidities are common among type 2 diabetes (T2D) patients, and significantly increase the cost and burden of care. Both sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1 RA) improve key outcomes including major CV events, hospitalization for heart failure, and renal outcomes, albeit to varying degrees in different T2D populations. Materials and Methods: The authors reviewed evidence from GLP-1 RA and SGLT2i CV outcomes trials and real-world studies in Thailand and elsewhere. Results: The authors formulated recommendations to guide selection of anti-diabetes medication based on patients’ clinical characteristics and CV or renal risk profile. Conclusion: These recommendations could help guide management of CV/renal comorbidities and risk alongside glucose-lowering therapy for individual patients. Keywords: Type 2 diabetes mellitus; Cardiovascular diseases; Chronic kidney disease; Clinical outcomes; SGLT2i; GLP-1 RA

scholarly journals Potential cardiovascular benefits of GLP-1 analogues: evidence and implications for type 2 diabetes management

2020 ◽  
pp. 24-29
Author(s):  
M Vally
Keyword(s):  
Type 2 Diabetes ◽  
Cardiovascular Risk ◽  
Paradigm Shift ◽  
Diabetes Management ◽  
Clinical Trial Data ◽  
Sglt2 Inhibitors ◽  
Atherosclerotic Cardiovascular Disease ◽  
Glucagon Like Peptide ◽  
Glucagon Like Peptide 1

Glucagon-like peptide-1 (GLP-1) analogues are an injectable therapy used in the management of type 2 diabetes. These drugs seem to reduce cardiovascular risk factors and clinical trial data seems to suggest that liraglutide and semaglutide reduce cardiovascular risk in patients with type 2 diabetes and concomitant atherosclerotic cardiovascular disease. The search for agents such as these (and SGLT2 inhibitors) that not only manage diabetes but also reduce cardiovascular risk has resulted in a paradigm shift in the way diabetes can be managed.

Abstract 15526: Glucagon-like Peptide-1 Receptor Agonists Reduce Adverse Cardiovascular Disease (CVD) Events in Patients With Type 2 Diabetes: An Assessment of Heterogeneity Among CVD Outcomes and a Meta-regression Analysis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Simran Grewal ◽  
Ninad Zaman ◽  
Louis Borgatta ◽  
Matthew Nudy ◽  
Brandon Peterson
Keyword(s):  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Cardiovascular Death ◽  
Nonfatal Stroke ◽  
Significant Heterogeneity ◽  
Receptor Agonists ◽  
Meta Regression ◽  
Glucagon Like Peptide ◽  
Glucagon Like Peptide 1

Introduction: Recent evidence suggests glucagon-like peptide-1 receptor agonists (GLP-1 RA) reduce adverse cardiovascular disease (CVD) events. The objective of this study is to analyze randomized controlled trials (RCTs) testing GLP-1 RA’s effects on CVD among participants with type 2 diabetes (T2DM). Methods: RCTs comparing GLP-1 RA versus placebo among participants with T2DM were identified using PubMed and Cochrane databases. The endpoints of this analysis included major adverse cardiovascular events (MACE; a composite of cardiovascular death, nonfatal myocardial infarction (MI), and nonfatal stroke), and the individual components of MACE. The primary analysis calculated risk ratios (RR) and 95% confidence intervals (CI) for each endpoint. Heterogeneity for each endpoint was calculated using Chi 2 and I 2 tests. For any endpoint with significant heterogeneity, a meta-regression was performed using baseline hemoglobin A1C (A1C) in each RCT as the moderator and a R 2 value was calculated. Results: 7 RCTs (N = 56,004) were identified with 174,163 patient years of follow-up. GLP-1 RA reduced MACE [RR 0.89, 95% CI 0.83-0.95], cardiovascular death [RR 0.88, 95% CI 0.81-0.95], and nonfatal stroke [RR 0.85, 95% CI 0.77-0.94]. There was no significant heterogeneity among these RCTs (Figure 1). GLP-1 RA did not reduce nonfatal MI [RR 0.91, 95% CI 0.82-1.02]. However, there was significant heterogeneity among these RCTS (Chi 2 =12.94, p=0.04, I 2 =54%). When accounting for A1C in the regression model, there was no longer significant heterogeneity for this endpoint (p=0.23, I 2 =27%). A relationship between A1C and GLP-1 RA’s effect on nonfatal MI (R 2 =0.64, Figure 1) was observed when performing the meta-regression. Conclusion: GLP-1 RA reduced MACE, cardiovascular death, and nonfatal stroke in patients with T2DM with minimal heterogeneity among RCTs. GLP-1 RA did not reduce nonfatal MI, however there may be an association between A1C and GLP-1 RA’s effect on nonfatal MI.

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