scholarly journals Second-Line Therapy for Type 2 Diabetes Management: The Treatment/Benefit Paradox of Cardiovascular and Kidney Comorbidities

Diabetes Care ◽  
2021 ◽  
pp. dc202977
Author(s):  
Rozalina G. McCoy ◽  
Holly K. Van Houten ◽  
Pinar Karaca-Mandic ◽  
Joseph S. Ross ◽  
Victor M. Montori ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Diabetes Management ◽  
Second Line ◽  
Second Line Therapy ◽  
Treatment Benefit ◽  
Line Therapy

Individualized HbA1c Targets in People with Type 2 Diabetes Initiating Second-Line Therapy—The Global DISCOVER Study

Diabetes ◽  
2018 ◽  
Vol 67 (Supplement 1) ◽  
pp. 1629-P
Author(s):  
KAMLESH KHUNTI ◽  
HUNGTA CHEN ◽  
JAVIER CID-RUZAFA ◽  
PETER FENICI ◽  
MARILIA B. GOMES ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Second Line ◽  
Second Line Therapy ◽  
Line Therapy

scholarly journals Combination of Empagliflozin and Linagliptin as Second-Line Therapy in Subjects With Type 2 Diabetes Inadequately Controlled on Metformin

Diabetes Care ◽  
2015 ◽  
Vol 38 (3) ◽  
pp. 384-393 ◽  
Author(s):  
Ralph A. DeFronzo ◽  
Andrew Lewin ◽  
Sanjay Patel ◽  
Dacheng Liu ◽  
Renee Kaste ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Second Line ◽  
Second Line Therapy ◽  
Line Therapy

scholarly journals P1011CARDIOVASCULAR OUTCOME TRIALS (CVOT) USING NEW ANTI-DIABETIC AGENTS IN CHRONIC KIDNEY DISEASE: A SYSTEMATIC REVIEW AND META-ANALYSIS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Nadia Sarween ◽  
Nuvreen Phagura ◽  
Adnan Sharif
Keyword(s):  
Systematic Review ◽  
Type 2 Diabetes ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Meta Analysis ◽  
Second Line ◽  
Second Line Therapy ◽  
Receptor Agonists ◽  
Line Therapy

Abstract Background and Aims The latest consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) recommends metformin and lifestyle intervention as first-line therapy for type 2 diabetes. Second-line therapy recommendation is the use sodium-glucose cotransporter 2 (SGLT 2) inhibitors (if estimated glomerular filtration rate [eGFR] is adequate) or GLP-1 receptor agonists if eGFR is inadequate (or SGLT-2 inhibitors not tolerated). No recommendation is made for dipeptidyl peptidase-4 (DPP-4) inhibitors. Therapy choices are limited for patients with both type 2 diabetes and moderate-to-severe chronic kidney disease (CKD) and it is unclear from published data if observed cardiovascular benefits of new anti-diabetic agents extend to the CKD cohort. The aim of this study was to undertake a systematic review of all published CVOT trials using new anti-diabetic agents (GLP-1 receptor agonist, DPP-4 inhibitor, SGLT 2 inhibitor). Method We searched MEDLINE (via PubMed and the Cochrane Central Register of Controlled Trials) up to 1st December 2019. Data was stratified by trial entry eGFR into normal (eGFR ≥60 ml/min) and CKD (eGFR <60 ml/min), with data extracted for primary major cardiovascular event (MACE) rates such as cardiovascular death, stroke and/or myocardial infarct. A meta-analysis with random effects model was performed to estimate overall hazard ratios (HRs) for MACE with new anti-diabetic agents stratified by eGFR. Inter-study heterogeneity was assessed with the I2 index and Cochran’s Q test. Results We analysed 13 studies from 16 that were eligible after our search strategy, with 2 excluded due lack of data stratified by eGFR and 1 excluded due to combined MACE/renal outcomes. The studies (GLP-1 agonists, n=6; DPP-4 inhibitors, n=4; SGLT 2 inhibitors, n=3) had a combined total of 128,266 participants (22.1% with eGFR <60 ml/min). HR for MACE with GLP-1 agonists for participants with eGFR ≥60 ml/min was 0.87 (95% CI 0.77-0.98; p=0.02) and for participants with eGFR <60 ml/min was 0.90 (95% CI 0.78-1.04; p=0.14). HR for MACE with DPP-4 inhibitors for participants with eGFR ≥60 ml/min was 0.99 (95% CI 0.92-1.07; p=0.86) and for participants with eGFR <60 ml/min was 0.99 (95% CI 0.91-1.08; p=0.86). HR for MACE with SGLT 2 inhibitors for participants with eGFR ≥60 ml/min was 0.98 (95% CI 0.88-1.10; p=0.78) and for participants with eGFR <60 ml/min was 0.82 (95% CI 0.70-0.96; p=0.01). Significant heterogeneity was observed in the meta-analyses for each new anti-diabetic therapy drug class stratified by eGFR. Conclusion Among the new anti-diabetic agents, our study suggests efficacy for prevention of MACE in the setting of CKD exists only for SGLT 2 inhibitors and not with GLP-1 receptor agonists or DPP-4 inhibitors. Targeted CVOT studies incorporating participants with diabetes and CKD are critical to guide glycaemic management in these high-risk patients. Until then, we suggest recommendations for second-line therapy in patients with type 2 diabetes and renal impairment should be amended to reflect the current evidence base supporting prevention of MACE with SGLT 2 inhibitors versus other new anti-diabetic agents.

1062-P: Real-World Effectiveness of Gliclazide MR vs. Sitagliptin as Second-Line Therapy in People with Type 2 Diabetes Uncontrolled on Metformin

Diabetes ◽  
2020 ◽  
Vol 69 (Supplement 1) ◽  
pp. 1062-P
Author(s):  
FRANCESCO ZACCARDI ◽  
VIVIANA CORTESE ◽  
EMMANUELLE JACQUOT ◽  
FREYA TYRER ◽  
SAMUEL SEIDU ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Real World ◽  
Second Line ◽  
Second Line Therapy ◽  
Line Therapy

40-OR: Quality of Life in People with Type 2 Diabetes following Initiation of Second-Line Therapy: DISCOVER

Diabetes ◽  
2020 ◽  
Vol 69 (Supplement 1) ◽  
pp. 40-OR
Author(s):  
ANTONIO NICOLUCCI ◽  
HUNGTA CHEN ◽  
ANDREW COOPER ◽  
MARILIA B. GOMES ◽  
LINONG JI ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Type 2 Diabetes ◽  
Second Line ◽  
Second Line Therapy ◽  
Line Therapy
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