Research prompts better use of life-saving treatments

In a recent study published in american heart journalresearchers investigated efficacy of current approaches to reduce the risk of cardiovascular events in type 2 diabetic (T2D).

study: Contemporary use of cardiovascular risk reduction strategies in type 2 diabetes. Insights from The Diabetes Collaborative Registry. Image credit: siam.pukkato / Shutterstock.com

T2D and cardiovascular health

Patients with type 2 diabetes are at increased risk of hospitalization, reduced quality of life, and economic costs from cardiovascular complications. These complications account for more than 50% of her deaths in type 2 diabetes, and their incidence continues to rise.

Glucagon-like peptide 1 receptor agonists (GLP-1RA) and sodium-glucose cotransporter 2 inhibitors (SGLT2i) have both been developed to lower glucose levels, reducing mortality as well as renal and cardiovascular health. has been shown to improve , among high-risk T2D patients.

About research

In this study, researchers are analyzing trends in the use of evidence-based treatments to reduce cardiovascular risk over time in people with type 2 diabetes.

This study included patients with type 2 diabetes who were prescribed at least one glucose-lowering therapy from a list of drug classes including insulin, sulfonylureas, metformin, thiazolidinediones (TZDs), GLP1RA, DPP-4i, and SGLT2i. Adult patients aged 18 years and older participated.

This study focused on several subgroups of patients, including those with heart failure (HF), atherosclerotic cardiovascular disease (ASCVD), and chronic kidney disease (CKD). Patients within the ASCVD subgroup had a variety of conditions, including peripheral artery disease, coronary artery disease (CAD), and cerebrovascular disease. The cerebrovascular disease subgroup consisted of patients with transient ischemic attack, previous stroke, and carotid intervention.

Researchers calculated the Diabetes Cardiovascular Composite Score (DCCS) to determine the effectiveness of cardiovascular risk-reduction techniques in individual patients. This score indicates the percentage of drugs recommended to patients for optimal cardiovascular risk reduction.

Five potential agents were evaluated for patient eligibility, including GLP-1RA, SGLT2i, a statin, an antithrombotic therapy, and an angiotensin-converting enzyme inhibitor (ACEI). angiotensin receptor blocker (ARB), and angiotensin receptor neprilysin inhibitor (ARNI).

result

A total of 1,001,542 patients from 391 sites were included in the current study. The cohort had a mean age of approximately 66 years and included 512,807 men.

Over 627,146 patients had at least one high-risk condition, including documented ASCVD, heart failure, or CKD. More specifically, 518,270 patients reported her ASCVD, 177,518 documented HF diagnosis, and 230,519 her CKD. In addition, mean systolic blood pressure was nearly 130 mmHg, mean body mass index (BMI) was approximately 33 kg/m2, and mean hemoglobin A1C (HbA1C) was 7.4%.

Metformin was the most commonly prescribed hypoglycemic agent, with a prevalence of 73.1%. His 36.6% of patients used insulin, 12.5% ​​used his SGLT2i, and 12.9% used his GLP-1RA.

SGLT2i or GLP-1RA use in patients increased from 4.1% to 28.8% from 2013 to 2019. However, DCCS decreased from 72% to 52% from 2013 to 2019 as DCCS eligible medication options increased.

Approximately 18% of 627,146 patients diagnosed with ASCVD, HF, or CKD received SGLT2i or GLP-1RA medication. A young male patient with no reported HF, ASCVD, or CKD who was prescribed insulin was more frequently prescribed his SGLT2 inhibitor. GLP-1RA drugs were frequently prescribed to young patients, women, patients with no documented ASCVD or HF, and patients taking insulin.

Male gender and ASCVD diagnosis were associated with greater likelihood of using GLP-1RA or SGLT2i. was less likely to be

Older patients, males, patients with certain medical conditions such as ASCVD, CKD, or HF, and patients receiving insulin showed higher DCCS. A hierarchical linear model revealed that male gender and her CKD diagnosis were associated with higher DCCS, whereas ASCVD or HF diagnosis correlated with lower DCCS.

Conclusion

Study results revealed a positive trend in the use of glucose-lowering drugs in terms of cardiovascular risk reduction over time. , especially in patients with high-risk conditions.

Current research highlights the importance of educating both cardiologists and patients about the benefits of treatment beyond glucose reduction. Educating the healthcare professional on the benefits of her SGLT2i and GLP-1RA agents and providing guidance on prescribing these agents and adopting a team-based model of care will help shift awareness of these agents away from hypoglycemic agents. Helps convert to cardiovascular reducing means. Risk for T2D patients.