Improving Outcomes—A Multidisciplinary Year in Review

In this mini-symposium, experts shared their perspectives on improving outcomes across the cardio renal metabolic spectrum of diabetes. Here are the key highlights:

• SGLT2 inhibitors are the standard of care for all eligible individuals with diabetes and heart failure.
• The cardio-renal benefits of SGLT2 inhibitors in patients with diabetes and chronic kidney disease are well-established, but the drug remains highly underprescribed by nephrologists.
• Efficient risk stratification, targeted individualized therapy, and a multidisciplinary approach can improve outcomes in diabetes.

Joint ADA/EASD—Management of Hyperglycemia in Type 2 Diabetes

The 2022 draft updates to the American Diabetes Association (ADA)/European Association for the Study of Diabetes (EASD) consensus covers key developments in diabetes research and provides a framework for the management of hyperglycemia in adults with type 2 diabetes. A holistic person-centered approach should be followed in type 2 diabetes management with the person with diabetes at the center of care. Glycemic management, weight management, cardiovascular risk factor management, and cardiorenal protection should drive the choice of glucose-lowering therapies.

SGLT2 Inhibitors and Risk of Incident Atrial Fibrillation in Older Adults with Type 2 Diabetes

Sodium-glucose cotransporter-2 inhibitors (SGLT2is) may be beneficial in older adults with type 2 diabetes and risk of atrial fibrillation. In a large population-based cohort including more than 300,000 older adults with type 2 diabetes, the initiation of SGLT2i compared with dipeptidyl peptidase-4 inhibitors or glucagon-like peptide-1 receptor agonists were associated with a 10 to 18% reduction in the risk of incident atrial fibrillation.

Prescription patterns of CV and kidney protective therapies among patients with type 2 diabetes

A cross-sectional analysis that evaluated the contemporary prescription patterns of sodium‐glucose cotransporter 2 inhibitors (SGLT2i) and glucagon‐like peptide‐1 receptor agonists (GLP‐1RA), found that prescription of these drugs was low among patients with type 2 diabetes and concomitant ASCVD, heart failure, and chronic kidney disease (CKD). In patients with CKD, the presence of severe albuminuria was inversely associated with the prescription of SGLT2i and GLP-1RA, independent of eGFR. Higher ASCVD risk and higher end-stage kidney disease risk were inversely associated with the prescription of these medications.

Consensus- New Joint Statement from ADA and KDIGO on Management of Diabetes and CKD

As per the American Diabetes Association (ADA)/ Kidney Disease Improving Global Outcomes (KDIGO) consensus, screening is the foundation for the diagnosis and treatment of kidney disease. The consensus recommends sodium-glucose cotransporter 2 (SGLT2) inhibitor as first-line therapy in people with diabetes and chronic kidney disease. The panel also highlights the key role of concurrent first-line treatment with a renin-angiotensin system inhibitor, metformin, and statin.

Effectiveness and Safety of Empagliflozin in Routine Care: Results from the Empagliflozin Comparative Effectiveness and Safety (EMPRISE) Study

The EMPRISE study used real-world data to evaluate the cardiovascular effectiveness and safety of empagliflozin in routine care patients with type 2 diabetes across the spectrum of CV disease. In clinical practice, compared to dipeptidyl peptidase-4 inhibitor (DPP-4i), empagliflozin was associated with a reduced risk of heart failure hospitalization, composite of myocardial infarction and stroke, and all-cause mortality with a safety profile consistent with documented information.

Favorable Kidney Outcomes Are Associated with Empagliflozin vs. DPP4i in Patients with Diabetes and Normal Kidney Function Real-World Evidence

Empagliflozin and all SGLT2i therapies possess long-term benefits in kidney disease prevention among patients with type 2 diabetes and low KDIGO risk. In a study using a large Israeli database, compared to dipeptidyl peptidase-4 inhibitors (DPP4i), empagliflozin was associated with a lower risk for adverse kidney outcomes (HR 0.80 (95% CI 0.65,0.97; p=0.026)).

Cardiovascular Effectiveness of Empagliflozin vs. Glucagon-Like Peptide-1 Receptor Agonists or Liraglutide in the EMPRISE Study

In real-world type 2 diabetes patients, empagliflozin was associated with a 30% relative risk reduction in hospitalization for heart failure compared with glucagon-like peptide 1 receptor agonists (GLP-1 RA) or liraglutide. The risk of myocardial infarction, stroke, and all-cause mortality was similar between the groups.