What do clinical guidelines from diabetes, cardiology, and endocrinology associations have in common? A case study quiz with an evidence-based answer explains.
Clinical treatment guidelines from leading professional societies in diabetes, cardiology, and endocrinology in the US and Europe now recommend use of 2 classes of antihyperglycemic medications for patients with type 2 diabetes (T2D) and existing atherosclerotic cardiovascular diseae (ASCVD), heart failure, chronic kidney disease, or who are at high risk for ASCVD.
Agents from the classes of glucagon-like peptide-1 receptor agonists (GLP-1 RA) and the sodium-glucose cotransporter 2 (SGLT2) inhibitors are recommended for with or at risk for cardiac and renal disease regardless of glycemic status.
In the following slides, meet a patient with T2D and comorbidities who requires treatment intensification. How would you change his current regimen? What is the evidence for that choice? And, what do the most prominent treatment guidlines say?
A 52-year-old man with history of CAD s/p CABG and ischemic cardiomyopathy presents to clinic after being referred by his cardiologist for management of T2D, diagnosed 5 years ago.
Q: Which agent, if initiated, would benefit the patient in terms of reducing the likelihood of another hospitalization for HF?
Answer: A. Dapagliflozin 10 mg/d. Of the options listed, only the sodium glucose-cotransporter 2 (SGLT2) inhibitor dapagliflozin has an FDA indication to reduce risk of HF hospitalization in patients with T2D and CVD or multiple CVD risk factors. This indication is based on data from DECLARE-TIMI 58 trial, in which patients with T2D, less than half of whom had established CVD, were randomized to either placebo or dapagliflozin 10 mg/d.