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Do we sufficiently implement the current ADA/EASD recommendations for treating patients with type 2 diabetes mellitus?


Authors: Emil Martinka
Authors‘ workplace: Národný endokrinologický a diabetologický ústav, n. o., Ľubochňa
Published in: Forum Diab 2019; 8(2): 63-70
Category: Review Article

Overview

The main cause of morbidity and mortality in patients with type 2 diabetes mellitus (DM2T) are cardiovascular events and diseases (CVD+). Their occurrence is not only 2–5 times more frequent in DM2T than in non-DM2T peers, but it also has a more severe course, the treatment is more demanding and the prognosis is worse. The incidence of CVD+ is relatively high on average in Slovak DM2T patients (about 37%, which is more than 30% in Europe and 32.2% in the world). CVD+ is already significantly (22%) present at the time of diagnosis (22%), as well as in the first years of disease in patients not adequately controlled with metformin monotherapy (31%). The mortality of patients with DM2T and CVD+ is 3 times higher (35.3/1000 patients per year/PPY) than those with CVD- (11.8/1000 PPY). While in Europe, mortality rates for DM2T patients range from 16 to 50 deaths per 1,000 PPY), according to the results of the Slovak NEFRITI-II study (2014–2018), this was 20.5/1,000 PPY. According to the latest recommendations of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) of 2018, one of the major considerations in the choice of treatment is whether the patient is suffering from atherosclerotic CVD+, including peripheral arterial disease, whether he has experienced a cardiovascular event (myocardial infarction, stroke), has heart failure, or has chronic kidney disease (CKD+). If the patient is in such a category, the recommended procedure is to add and prefer a drug with a confirmed cardiovascular, resp. a renal benefit that is currently demonstrated by SGLT2i or GLP1Ra. However, according to the results of the NEFRITI-II study, the use of cardioprotective groups of antidiabetic agents lags significantly behind the prevalence of CVD+ and is the same in patients with CVD+ and CVD-, suggesting that more glycemic than cardiovascular or renal indications are still being used to select these antidiabetic agents. It is therefore necessary to emphasize the importance of CVD+ in the work of diabetologists and to point out the benefits of SGLT2i and GLP1Ra in patients with CVD+. One of the key issues for the qualitative improvement of the medical treatment of our patients is also making SGLT2i available in a dual combination to metformin by modifying the indication limitations.

Keywords:

mortality – morbidity – cardiovascular – ADA/EASD recommendations 2018


Sources
  1. Gerstein HC, Miller ME, Byington RP et al. [The Action to Control Cardiovascular Risk in Diabetes Study Group]. Effects of Intensive Glucose Lowering in Type 2 Diabetes. N Engl J Med 2008; 358(24): 2545–2559. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJMoa0802743ACCORD>.
  2. Davies MJ, D‘Alessio DA, Fradkin J et al. Management of Hyperglycemia in Type 2 Diabetes, 2018. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care 2018; 41(12): 2669–2701. Dostupné z DOI: <https://doi.org/10.2337/dci18–0033>.
  3. Einarson TR, Acs A, Ludwig Ca et al. Cardiovasc Diabetol 2018, 17(1);:83. Dostupné z DOI: <https://doi.org/10.1186/s12933–018–0728–6>.
  4. Gaede P, Lund-Andersen H, Parving HH et al. Effect of a Multifactorial Intervention on Mortality in Type 2 Diabetes. N Engl J Med 2008; 358(6): 580–591. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJMoa0706245>.
  5. Gregg EW, Cheng YJ, Srinivasan M et al. Trends in cause-specific mortality among adults with and without diagnosed diabetes in the USA: An epidemiological analysis of linked national survey and vital statistics data. Lancet 2018; 391(10138): 2430–2440. Dostupné z DOI: <http://dx.doi.org/10.1016/S0140–6736(18)30314–3>.
  6. Green JB, Bethel MA, Armstrong PW et al.: Effect of Sitagliptin on Cardiovascular Outcomes in Type 2 Diabetes. N Engl J Med 2015; 373(3): 232–242. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJMoa1501352>.
  7. Haffner SM, Lehto S, Rönnemaa T et al. Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med 1998; 339(4): 229–234. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJM199807233390404>.
  8. Holman RR, Bethel MA, Mentz RJ, et al., on behalf of the EXSCEL Study Group. Effects of Once-Weekly Exenatide on Cardiovascular Outcomes in Type 2 Diabetes. N Engl J Med 2017; 377: 1228–1239.
  9. Johansen OE1, Neubacher D, von Eynatten M et al. Cardiovascular safety with linagliptin in patients with type 2 diabetes mellitus: a pre-specified, prospective, and adjudicated meta-analysis of a phase 3 programme. Cardiovasc Diabetol 2012; 11:3. Dostupné z DOI: <http://dx.doi.org/10.1186/1475–2840–11–3>.
  10. Loukine L., Waters, Ch et al.: Impact of diabetes mellitus on life expectancy and health-adjusted life expectancy in Canada. Popul Health Metr 2012; 10(1): 7. Dostupné z DOI: <http://dx.doi.org/10.1186/1478–7954–10–7>.
  11. Marso SP, Daniels GH, Brown-Frandsen K et al. Liraglutide and Cardiovascular Outcomes in Type 2 Diabetes. N Engl J Med 2016; 375(4): 311–322. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJMoa1603827>.
  12. Marso SP, Bain SC, Consoli A et al. Semaglutide and Cardiovascular Outcomes in Patients with Type 2 Diabetes. N Engl J Med 2016; 375(19): 1834–1844. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJMoa1607141>.
  13. Martinka E, Tkáč I, Mokáň M (eds). Interdisciplinárne štandardy diagnostiky a liečby diabetes mellitus, jeho komplikácií a najvýznamnejších sprievodných ochorení. Forum Diab 2018; 7(2; Suppl 1): 5–153.
  14. Martinka E. Kardiovaskulárna morbidita a mortalita pacientov s diabetes mellitus 2. typu na Slovensku. Výsledky štúdie NEFRITI II. Edukačný portál SDiA 2019. Dostupné z WWW: <http://lekar.sdia.sk/sdia-lekarske-profesne-zdruzenie-aktuality/170/kardiovaskularna-morbidita-a-mortalita-pacientov-s-diabetes-mellitus-2-typu-na-slovensku-vysledky-studie-nefriti-ii/>.
  15. Martinka E. Spektrum liečby a využívanie kardioprotektívnych molekúl u pacientov s diabetes mellitus 2. typu s prítomným kardiovaskulárnym ochorením na Slovensku. Výsledky štúdie NEFRITI II. Edukačný portál SDiA 2019. Dostupné z WWW: <http://lekar.sdia.sk/sdia-lekarske-profesne-zdruzenie-aktuality/177/spektrum-liecby-a-vyuzivanie-kardioprotektivnych-molekul-u-pacientov-s-diabetes-mellitus-2-typu-s-pritomnym-kardiovaskularnym-ochorenim-na-slovensku-vysledky-studie-nefriti-ii/>.
  16. Martinka E. Výber liečby do dvojkombinácie pri nedostatočnej liečbe metformínom samotným. Výsledky štúdie DiaSTATUS-2. Forum Diab 2019; 8(2): 117–127.
  17. Monesi L, Baviera M, Marzona I et al. Prevalence, incidence and mortality of diagnosed diabetes: evidence from an Italian population-based study. Diabet Med 2012; 29(3): 385–392. Dostupné z DOI: <http://dx.doi.org/10.1111/j.1464–5491.2011.03446.x>.
  18. MZ SR. Zoznam kategorizovaných liekov 1. 3. 2019–31. 3. 2019. Dostupné z WWW: <http://www.health.gov.sk/Clanok?lieky201903>.
  19. McEwen LN, Karter AJ, Waitzfelder BE et al. Predictors of Mortality Over 8 Years in Type 2 Diabetic Patients. Translating Research Into Action for Diabetes (TRIAD). Diabetes Care 2012; 35(6): 1301–1309. Dostupné z DOI: <http://dx.doi.org/10.2337/dc11–2281>.
  20. Neal B, Perkovic V, Mahaffey KW et al. Canagliflozin and Cardiovascular and Renal Events in Type 2 Diabetes. N Engl J Med 2017; 377: 644–657. <http://dx.doi.org/10.1056/NEJMoa1611925>.
  21. Rosenstock J, Perkovic V, Alexander JH https://cardiab.biomedcentral.com/articles/10.1186/s12933–018–0682–3 – Aff3et al. Rationale, design, and baseline characteristics of the CArdiovascular safety and Renal Microvascular outcomE study with LINAgliptin (CARMELINA®): a randomized, double-blind, placebo-controlled clinical trial in patients with type 2 diabetes and high cardio-renal risk. Cardiovasc Diabetol 2018; 17:39. Dostupné z DOI: <http://dx.doi.org/10.1186/s12933–018–0682–3>.
  22. Pildava S, Strēle I, Briģis G. The mortality of patients with diabetes mellitus in Latvia 2000–2012. Medicina (Kaunas) 2014; 50(2): 130–136. Dostupné z DOI: <http://dx.doi.org/10.1016/j.medici.2014.06.005>.
  23. Scirica BM, Bhatt DL, Braunwald E et al. Saxagliptin and Cardiovascular Outcomes in Patients with Type 2 Diabetes Mellitus. N Engl J Med 2013; 369(14): 1317–1326. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJMoa1307684>.
  24. Shah AD, Langenberg C, Rapsomaniki E et al. Type 2 diabetes and incidence of cardiovascular diseases: a cohort study in 1·9 million people. Lancet Diabetes Endocrinol 2015; 3(2): 105–113. Dostupné z DOI: <http://dx.doi.org/10.1016/S2213–8587(14)70219–0>.
  25. Schernthaner G, Lehmann R, Prázný M et al. Translating recent results from the Cardiovascular Outcomes Trials into clinical practice: recommendations from the Central and Eastern European Diabetes Expert Group (CEEDEG). Cardiovasc Diabetol 2017; 16(1): 137. Dostupné z DOI: <http://dx.doi.org/10.1186/s12933–017–0622–7>.
  26. Schramm TK, Gislason GH, Vaag A et al. Mortality and cardiovascular risk associated with different insulin secretagogues compared with metformin in type 2 diabetes, with or without a previous myocardial infarction: a nationwide study. Eur Heart J 2011; 32(15): 1900–1908. Dostupné z DOI: <http://dx.doi.org/10.1093/eurheartj/ehr077>.
  27. SPC Jardiance. Dostupné z WWW: <https://www.medicines.org.uk/emc/product/5441/smpc>.
  28. SPC Victoza. Dostupné z WWW: <https://www.medicines.org.uk/emc/product/6585/smpc>.
  29. Ubink-Veltmaat LJ, Bilo HJ, Groenier KH et al. Prevalence, incidence and mortality of type 2 diabetes mellitus revisited: a prospective population-based study in The Netherlands (ZODIAC-1). Eur J Epidemiol 2003; 18(8): 793–800.
  30. Wiviott SD, Raz I, Bonaca MP et al. Dapagliflozin and Cardiovascular Outcomes in Type 2 Diabetes. N Engl J Med 2019; 380(4): 347–357. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJMoa1812389>.
  31. Zinman B, Wanner Ch, Lachin JM et al. Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes. N Engl J Med 2015; 373(22): 2117–2128. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJMoa1504720>.
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Diabetology Endocrinology Internal medicine

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