Special Edition: SGLT2 Inhibitors in Type 2 Diabetes: Cardiovascular & Renal Outcomes
This series is supported by an unrestricted educational grant from the Division of Cardiovascular & Metabolic Diseases of U.S. Medical at AstraZeneca Pharmaceuticals, LP. All material is intended for medical education purposes only and contains no promotional information.
Primary care providers play a pivotal role in helping patients with type 2 diabetes achieve early and sustained glycemic control while also reducing their risks of serious complications. Recent outcomes trials have shown that sodium–glucose cotransporter 2 inhibitors, also known as SGLT2 inhibitors (SGLT2i's), can help patients with type 2 diabetes lower their glucose levels while also lessening their risk for atherosclerotic cardiovascular disease, heart failure, and chronic kidney disease.
In this special three-episode series, Diabetes Core Update explores these trials in detail, with a focus on the beneficial effects of SGLT2i's. Cohosts Drs. Neil Skolnik and John Russell of Abington Memorial Hospital and the Temple University School of Medicine discuss how the dramatic results of these trials provide evidence to support a new person-centered approach in the management of type 2 diabetes, an updated set of outcomes-based diabetes treatment guidelines, and a wealth of newfound information that can be incorporated in everyday clinical practice.
Please listen to each episode by clicking on the podcast players below or by freely subscribing to Diabetes Core Update via Apple Podcasts, Amazon Music, Spotify, or your preferred podcast platform.
December 17, 2020
Diabetes Core Update: SGLT2i’s Inhibitor Series Part 3
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Total Time: 17:45 | File Size: 38.8 MB
In the third and final episode of this special series on "SGLT2 Inhibitors in Type 2 Diabetes: Cardiovascular & Renal Outcomes," Drs. Skolnik and Russell discuss the most recent large-scale trials that have focused on the cardiovascular effects associated with SGLT2 inhibitors, how the outcomes of those trials have influenced the latest treatment guidelines related to cardiovascular disease and risk management in patients with type 2 diabetes, and how SGLT2 inhibitors should be sequenced in the treatment of patients with type 2 diabetes and cardiovascular complications. Over the course of their discussion, Drs. Skolnik and Russell refer to the following articles:
Sources
Empagliflozin and Progression of Kidney Disease in Type 2 Diabetes. Wanner C, Inzucchi SE, Lachin JM, et al., for the EMPA-REG OUTCOME Investigators. N Engl J Med. 2016 Jul 28;375(4):323-34. doi:10.1056/NEJMoa1515920. PMID: 27299675.
Section 10. Cardiovascular Disease and Risk Management: Standards of Medical Care in Diabetes—2021. American Diabetes Association. Diabetes Care. 2021 Jan; 44(Supplement 1):S125-150. doi:10.2337/dc21-S010.
2020 Expert Consensus Decision Pathway on Novel Therapies for Cardiovascular Risk Reduction in Patients With Type 2 Diabetes: A Report of the American College of Cardiology Solution Set Oversight Committee. Das SR, Everett BM, Birtcher KK, Brown JM, et al. Am Coll Cardiol. 2020 Sep 1;76(9):1117-1145. doi:10.1016/j.jacc.2020.05.037. PMID: 32771263; PMCID: PMC7545583.
Dapagliflozin and Cardiovascular Outcomes in Type 2 Diabetes. Wiviott SD, Raz I, Bonaca MP, Mosenzon O, et al., for the DECLARE–TIMI 58 Investigators. N Engl J Med. 2019 Jan 24;380(4):347-357. doi: 10.1056/NEJMoa1812389. PMID: 30415602.
Cardiovascular and Renal Outcomes with Empagliflozin in Heart Failure. Packer M, Anker SD, Butler J, et al., for the EMPEROR-Reduced Trial Investigators. N Engl J Med. 2020 Oct 8;383(15):1413-1424. doi:10.1056/NEJMoa2022190. PMID: 32865377.
2021 Update to the 2017 ACC Expert Consensus Decision Pathway for Optimization of Heart Failure Treatment: Answers to 10 Pivotal Issues About Heart Failure With Reduced Ejection Fraction: A Report of the American College of Cardiology Solution Set Oversight Committee. Writing Committee, Maddox TM, Januzzi JL Jr, Allen LA, et al.. J Am Coll Cardiol. 2021 Feb 16;77(6):772-810. doi:10.1016/j.jacc.2020.11.022. PMID: 33446410.
How Should We Sequence the Treatments for Heart Failure and a Reduced Ejection Fraction? A Redefinition of Evidence-Based Medicine. McMurray JJV, Packer M. Circulation. 2021 Mar 2;143(9):875-877. doi:10.1161/CIRCULATIONAHA.120.052926. PMID: 33378214.
Biomarker-Based Risk Prediction of Incident Heart Failure in Pre-Diabetes and Diabetes. Pandey A, Vaduganathan M, Patel KV, Ayers C, et al. JACC Heart Fail. 2021 Mar;9(3):215-223. doi:10.1016/j.jchf.2020.10.013. PMID: 33422434.
This special series of Diabetes Core Update is supported by an unrestricted educational grant from the Division of Cardiovascular & Metabolic Diseases of U.S. Medical at AstraZeneca Pharmaceuticals, LP. All material is intended for medical education purposes only and contains no promotional information.
December 3, 2020
Diabetes Core Update: SGLT2i’s Inhibitor Series Part 2
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Total Time: 28:15 | File Size: 38.8 MB
In the second episode of this special three-part series on "SGLT2 Inhibitors in Type 2 Diabetes: Cardiovascular & Renal Outcomes," Drs. Skolnik and Russell examine the outcomes of several important clinical trials on the renal effects of SGLT2 inhibitors:
Sources
Empagliflozin and Progression of Kidney Disease in Type 2 Diabetes. Wanner C, Inzucchi SE, Lachin JM, et al., for the EMPA-REG OUTCOME Investigators. N Engl J Med. 2016 Jul 28;375(4):323-34. doi:10.1056/NEJMoa1515920. PMID: 27299675
Canagliflozin and Cardiovascular and Renal Events in Type 2 Diabetes. Neal B, Perkovic V, Mahaffey KW, et al., for the CANVAS Program Collaborative Group. N Engl J Med. 2017 Aug 17;377(7):644-657. doi:10.1056/NEJMoa1611925. PMID: 28605608
Dapagliflozin and Cardiovascular Outcomes in Type 2 Diabetes. Wiviott SD, Raz I, Bonaca MP, Mosenzon O, et al., for the DECLARE–TIMI 58 Investigators. N Engl J Med. 2019 Jan 24;380(4):347-357. doi:10.1056/NEJMoa1812389. PMID: 30415602
Cardiovascular Outcomes with Ertugliflozin in Type 2 Diabetes. Cannon CP, Pratley R, Dagogo-Jack S, Mancuso J, Huyck S, Masiukiewicz U, Charbonnel B, Frederich R, Gallo S, Cosentino F, Shih WJ, Gantz I, Terra SG, Cherney DZI, McGuire DK; VERTIS CV Investigators. N Engl J Med. 2020 Oct 8;383(15):1425-1435. doi: 10.1056/NEJMoa2004967. Epub 2020 Sep 23. PMID: 32966714
Canagliflozin and Renal Outcomes in Type 2 Diabetes and Nephropathy. Perkovic V, Jardine MJ, Neal B, et al., for the CREDENCE Trial Investigators. N Engl J Med. 2019 Jun 13;380(24):2295-2306. doi:10.1056/NEJMoa1811744. PMID: 30990260
Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction. McMurray JJV, Solomon SD, Inzucchi SE, et al., for the DAPA-HF Trial Committees and Investigators. N Engl J Med. 2019 Nov 21;381(21):1995-2008. doi:10.1056/NEJMoa1911303. PMID: 31535829
Effects of Dapagliflozin on Symptoms, Function, and Quality of Life in Patients With Heart Failure and Reduced Ejection Fraction: Results From the DAPA-HF Trial. Kosiborod MN, Jhund PS, Docherty KF, et al. Circulation. 2020 Jan 14;141(2):90-99. doi:10.1161/CIRCULATIONAHA.119.044138. PMID: 31736335
Cardiovascular and Renal Outcomes with Empagliflozin in Heart Failure. Packer M, Anker SD, Butler J, et al., for the EMPEROR-Reduced Trial Investigators. N Engl J Med. 2020 Oct 8;383(15):1413-1424. doi:10.1056/NEJMoa2022190. PMID: 32865377
Dapagliflozin in Patients with Chronic Kidney Disease. Heerspink HJL, Stefánsson BV, Correa-Rotter R, et al., for the DAPA-CKD Trial Committees and Investigators. N Engl J Med. 2020 Oct 8;383(15):1436-1446. doi:10.1056/NEJMoa2024816. PMID: 32970396
In episode 3 of this series, Drs. Skolnik and Russell will take a closer look into the cardiovascular effects associated with SGLT2 inhibitors and will discuss the practical aspects and clinical implications of their use in the treatment of patients with type 2 diabetes.
This special series of Diabetes Core Update is supported by an unrestricted educational grant from the Division of Cardiovascular & Metabolic Diseases of U.S. Medical at AstraZeneca Pharmaceuticals, LP. All material is intended for medical education purposes only and contains no promotional information.
December 3, 2020
Diabetes Core Update: SGLT2i’s Inhibitor Series Part 1
Play Episode
Total Time: 25:24 | File Size: 48.8 MB
In the first episode of this special three-part series on "SGLT2 Inhibitors in Type 2 Diabetes: Cardiovascular & Renal Outcomes," Drs. Skolnik and Russell review in detail the dramatic results from the following clinical trials:
Sources
Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes. Zinman B, Wanner C, Lachin JM, et al. N Engl J Med. 2015;373(22):2117-2128. doi:10.1056/NEJMoa1504720. PMID: 26378978
Canagliflozin and Cardiovascular and Renal Events in Type 2 Diabetes. Neal B, Perkovic V, Mahaffey KW, et al. N Engl J Med. 2017;377(7):644-657. doi:10.1056/NEJMoa1611925. PMID: 28605608
Dapagliflozin and Cardiovascular Outcomes in Type 2 Diabetes. Wiviott SD, Raz I, Bonaca MP, et al. N Engl J Med. 2019;380(4):347-357. doi:10.1056/NEJMoa1812389. PMID: 30415602
Study summary: Evaluation of Ertugliflozin Efficacy and Safety Cardiovascular Outcomes Trial - VERTIS CV. Posted 31 August 2020. https://www.acc.org/latest-in-cardiology/clinical-trials/2020/06/16/11/24/vertis
In episodes 2 and 3 of this series, Drs. Skolnik and Russell will take a closer look into the cardiorenal effects associated with SGLT2 inhibitors and will discuss the practical aspects and clinical implications of their use in the treatment of patients with type 2 diabetes.
This special series of Diabetes Core Update is supported by an unrestricted educational grant from the Division of Cardiovascular & Metabolic Diseases of U.S. Medical at AstraZeneca Pharmaceuticals, LP. All material is intended for medical education purposes only and contains no promotional information.
REFERENCES AND RELATED RESOURCES
American Diabetes Association: Standards of Medical Care in Diabetes—2020
Diabetes Core Update is a monthly audio podcast devoted to presenting and discussing the latest clinically relevant articles from ADA’s four scholarly journals: Diabetes, Diabetes Care, Clinical Diabetes, and Diabetes Spectrum. Users can freely access previous episodes of Diabetes Core Update here.
