Treatment algorithm in patients with type 2 diabetes and atherosclerotic cardiovascular disease or high/very high cardiovascular risk

2019 ◽  
Vol 41 (2) ◽  
pp. 331-331
Author(s):  
Giovanni Targher ◽  
Christopher D Byrne
Keyword(s):  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Cardiovascular Risk ◽  
Treatment Algorithm ◽  
Atherosclerotic Cardiovascular Disease ◽  
High Cardiovascular Risk ◽  
Very High

scholarly journals Clinical profiles and quality of care of subjects with type 2 diabetes according to their cardiovascular risk: an observational, retrospective study

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Basilio Pintaudi ◽  
Alessia Scatena ◽  
Gabriella Piscitelli ◽  
Vera Frison ◽  
Salvatore Corrao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Type 2 Diabetes ◽  
Quality Of Care ◽  
Cardiovascular Risk ◽  
High Risk ◽  
Cardiovascular Risk Factors ◽  
High Cardiovascular Risk ◽  
Very High

Abstract Background The European Society of Cardiology (ESC) recently defined cardiovascular risk classes for subjects with diabetes. Aim of this study was to explore the distribution of subjects with type 2 diabetes (T2D) by cardiovascular risk groups according to the ESC classification and to describe the quality indicators of care, with particular regard to cardiovascular risk factors. Methods The study is based on data extracted from electronic medical records of patients treated at the 258 Italian diabetes centers participating in the AMD Annals initiative. Patients with T2D were stratified by cardiovascular risk. General descriptive indicators, measures of intermediate outcomes, intensity/appropriateness of pharmacological treatment for diabetes and cardiovascular risk factors, presence of other complications and overall quality of care were evaluated. Results Overall, 473,740 subjects with type 2 diabetes (78.5% at very high cardiovascular risk, 20.9% at high risk and 0.6% at moderate risk) were evaluated. Among people with T2D at very high risk: 26.4% had retinopathy, 39.5% had albuminuria, 18.7% had a previous major cardiovascular event, 39.0% had organ damage, 89.1% had three or more risk factors. The use of DPP4-i markedly increased as cardiovascular risk increased. The prescription of secretagogues also increased and that of GLP1-RAs tended to increase. The use of SGLT2-i was still limited, and only slightly higher in subjects with very high cardiovascular risk. The overall quality of care, as summarized by the Q score, tended to be lower as the level of cardiovascular risk increased. Conclusions A large proportion of subjects with T2D is at high or very high risk. Glucose-lowering drug therapies seem not to be adequately used with respect to their potential advantages in terms of cardiovascular risk reduction. Several actions are necessary to improve the quality of care.

scholarly journals Pharmacological therapy and cardiovascular risk reduction for type 2 diabetes

2020 ◽  
Vol 66 (9) ◽  
pp. 1283-1288
Author(s):  
Eduardo Bello Martins ◽  
Eduardo Gomes Lima ◽  
Fábio Grunspun Pitta ◽  
Leticia Neves Solon Carvalho ◽  
Thiago Dias de Queiroz ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Cardiovascular Risk ◽  
Pharmacological Therapy ◽  
High Cardiovascular Risk ◽  
Cardiovascular Risk Reduction ◽  
Drug Classes ◽  
Clinical Benefits

SUMMARY The pharmacological therapy for type 2 diabetes mellitus has presented important advances in recent years, which has impacted the treatment of patients with established cardiovascular disease or with high cardiovascular risk. In this scenario, two drug classes have emerged and demonstrated clear clinical benefits: SGLT-2 inhibitors and GLP-1 agonists. The present review discusses the pharmacology, adverse effects, and clinical trials that have demonstrated the benefits of these medications in reducing cardiovascular risk.

scholarly journals Effects of dapagliflozin of the markers of fibrosis and inflammation in type 2 diabetes and very high cardiovascular risk

2021 ◽  
Vol 5 (4) ◽  
pp. 185-188
Author(s):  
D.A. Lebedev ◽  
◽  
A.Yu. Babenko ◽  
Keyword(s):  
Type 2 Diabetes ◽  
Cardiovascular Risk ◽  
Randomized Clinical Trials ◽  
High Sensitivity ◽  
Type I ◽  
High Cardiovascular Risk ◽  
Renal Outcomes ◽  
Positive Effects ◽  
Very High

Background: several randomized clinical trials have demonstrated that dapagliflozin, like other inhibitors of sodium-glucose cotransporter 2 (SGLT2), significantly improves cardiovascular and renal outcomes in type 2 diabetes (T2D). However, underlying mechanisms remain unclear. Aim: to assess changes in the levels of serum markers associated with fibrosis and inflammation in patients with T2D receiving dapagliflozin. Patients and Methods: this prospective single-center study included 27 patients aged 40–65 years with T2D that lasts more than 1 year and without verified atherosclerosis but multiple cardiovascular risk factors (i.e., dyslipidemia, obesity, hypertension). In addition to basic treatment for T2D, all patients received dapagliflozin 10 mg daily for 6 months. Before and 6 months after treatment, the levels of the markers of fibrosis (including procollagen type I carboxy-terminal propeptide/PICP) and inflammation were measured. Results: the median age was 56 [49; 61] years and the median duration of T2D was 7 [4; 12] years. After 6-month treatment with dapagliflozin, significant reduction in the concentration of PICP from 136.8 [100,4; 200,6] ng/ml to 104.8 [79.7; 162.0] ng/ml (р = 0.019). The levels of galectin-3, matrix metalloproteinase (MMP) 9, tissue inhibitor of MMP-1, growth stimulating expressed gene 2, high-sensitivity C-reactive protein, and N-terminal pro-atrial natriuretic peptide were similar at baseline and after 6-month treatment. Conclusions: 6-month treatment with dapagliflozin reduced the levels of PICP. Together with other mechanisms, this phenomenon illustrates the positive effects of dapagliflozin on cardiovascular and renal outcomes in T2D. KEYWORDS: type 2 diabetes, fibrosis, chronic inflammation, dapagliflozin, cardiovascular diseases. FOR CITATION: Lebedev D.A., Babenko A.Yu. Effects of dapagliflozin of the markers of fibrosis and inflammation in type 2 diabetes and very high cardiovascular risk. Russian Medical Inquiry. 2021;5(4):185–188 (in Russ.). DOI: 10.32364/2587-6821-2021-5-4-185-188.

scholarly journals Cost-effectiveness of screening of coronary artery disease in patients with type 2 DIABetes at a very high cardiovascular risk (SCADIAB study) rational and design

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Kamel Mohammedi ◽  
Nathalie Préaubert ◽  
Tanguy Cariou ◽  
Vincent Rigalleau ◽  
Ninon Foussard ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Coronary Artery Disease ◽  
Cardiovascular Risk ◽  
Coronary Artery ◽  
Lower Limb ◽  
High Cardiovascular Risk ◽  
Coronary Syndrome ◽  
Artery Disease ◽  
Very High

Abstract Background Screening for coronary artery disease (CAD) remains broadly performed in patients with type 2 diabetes (T2DM), although the lack of evidence. We conduct a real-world evidence (RWE) study to assess the risk of major clinical outcomes and economic impact of routine CAD screening in T2DM individuals at a very high cardiovascular risk. Methods SCADIAB is a comparative nationwide cohort study using data from the French National Health Data System. The main inclusion criteria are: age ≥ 40 years, DT2 diagnosed for ≥ 7 years, with ≥ 2 additional cardiovascular risk factors plus a history of microvascular or macrovascular disease, except CAD. We estimated ≥ 90,000 eligible participants for our study. Data will be extracted from 01/01/2008 to 31/12/2019. Eligible participants will be identified during a first 7-year selection period (2008–2015). Each participant will be assigned either in experimental (CAD screening procedure during the selection period) or control group (no CAD screening) on 01/01/2015, and followed for 5 years. The primary endpoint is the incremental cost per life year saved over 5 years in CAD screening group versus no CAD screening. The main secondary endpoints are: total 5-year direct costs of each strategy; incidence of major cardiovascular (acute coronary syndrome, hospitalization for heart failure, coronary revascularization or all-cause death), cerebrovascular (hospitalization for transient ischemic attack, stroke, or carotid revascularization) and lower-limb events (peripheral artery disease, ischemic diabetic foot, lower-limb revascularization or amputation); and the budget impact for the French Insurance system to promote the cost-effective strategy. Analyses will be adjusted for a high-dimension propensity score taking into account known and unknown confounders. SCADIAB has been funded by the French Ministry of Health and the protocol has been approved by the French ethic authorities. Data management and analyses will start in the second half of 2021. Discussion SCADIAB is a large and contemporary RWE study that will assess the economic and clinical impacts of routine CAD screening in T2DM people at a very high cardiovascular risk. It will also evaluate the clinical practice regarding CAD screening and help to make future recommendations and optimize the use of health care resources. Trial registration ClinicalTrials.gov Identifier: NCT04534530 (https://clinicaltrials.gov/ct2/show/NCT04534530)

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