Kim Kuebler DNP, APRN, ANP-BC, FAAN’s Post

American College of Physicians updated their guidelines on management of type 2 diabetes specifically highlighting the importance of incorporating SGLT2 inhibitors and GLP1 RA to reduce various risks of complications. Key features included - Metformin and lifestyle changes are initial steps in managing type 2 diabetes. - Consider patient preferences, benefits, harms, and costs when selecting additional therapies. - Prioritize SGLT-2 inhibitors for patients with CHF or CKD, and GLP-1 agonists for those at risk for stroke or needing weight loss. - Aim for HbA1c levels between 7% and 8% in most adults with type 2 diabetes. - Deintensify treatments for adults with HbA1c levels below 6.5%. - Self-monitoring of blood glucose may not be necessary with certain medication combinations. - Reduce or discontinue sulfonylureas or long-acting insulins when adding SGLT-2 inhibitors or GLP-1 agonists for glycemic control #weightloss #diabetes #GLP1RA

The ACP recommends prescribing an SGLT-2 inhibitor or GLP-1 agonist as an adjunct to metformin and lifestyle modifications to improve glycemic control among adults with type 2 diabetes. Specifically, the ACP recommends SGLT-2 inhibitors to reduce the risks for all-cause mortality, MACE, progression of CKD, and hospitalization due to CHF. To reduce the risk for all-cause mortality, MACE, and stroke, GLP-1 agonists are recommended.

For adults with type 2 diabetes and inadequate glycemic control, the authors recommend the addition of an SGLT-2 inhibitor or GLP-1 agonist to metformin and lifestyle modifications (strong recommendation). An SGLT-2 inhibitor can reduce the risk for all-cause mortality, major adverse cardiovascular events, chronic kidney disease progression, and hospitalization due to congestive heart failure. Use of a GLP-1 agonist can reduce the risk for all-cause mortality, major adverse cardiovascular events, and stroke.

The significance of this study is that patients do not have T2D. There are many CVOT trials with GLP-1 in T2D showing similar effects. But this is the first time we see treating obesity in an RCT with pharmacotherapy yielding these incredible results. “In patients with preexisting cardiovascular disease and overweight or obesity but without diabetes, weekly subcutaneous semaglutide at a dose of 2.4 mg was superior to placebo in reducing the incidence of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke at a mean follow-up of 39.8 months.” A big day for science, medicine and patients. https://lnkd.in/eHhd_9hY

📣 Exciting News Alert! 📣 The American College of Physicians (ACP) just released updated guidelines for managing type 2 diabetes, emphasizing the importance of incorporating SGLT-2 inhibitors and GLP-1 agonists alongside metformin and lifestyle interventions. 🩺💊 Check out the guidelines here: https://lnkd.in/dugvJJdU Key Takeaways: 1️⃣ GLP-1 agonists and SGLT-2 inhibitors are effective for controlling blood sugar levels. 2️⃣ High treatment costs are acknowledged, with strategies suggested to overcome this barrier. 3️⃣ DPP-4 inhibitors aren't recommended due to insufficient evidence. In case of any queries Feel free to reach out! 📩 #DiabetesCare #ACPGuidelines 🌟

The New England Journal of Medicine publishes Effects of Semaglutide on Chronic Kidney Disease in Patients with Type 2 Diabetes. From 3,533 participants with type 2 diabetes and chronic kidney disease, at three years those on semaglutide had a 24% reduction in kidney disease events, or death from kidney-related or cardiovascular causes. In addition, risk of major cardiovascular events was 18% lower, death from cardiovascular causes was 29% lower, and the risk of death from any cause 20% lower, in the GLP-1 group. You may recollect that back in October 2023, Novo Nordisk made a statement that it had stopped a major study of semaglutide on kidney disease – the FLOW trial. Sadly though, Black people made up only 4.5% of participants; in America, Black people are three times more likely to have kidney failure than white people. We still have much more work to do. https://lnkd.in/e9Txsv4P

Aims We investigated the associations between time in target range (TTR) of blood pressure (BP) and cardiovascular outcomes in patients with diabetes. Methods 4651 participants from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) BP trial were included in the present study. The diastolic BP target range was defined as 70 to 80 mm Hg, and the systolic as 120 to 140 mm Hg and 110 to 130 mm Hg for the standard and intensive therapy, respectively. Results After adjusting for covariates, 1-SD increase of diastolic TTR was significantly associated with lower risks of primary outcome (HR 0.82, 95% CI: 0.74–0.91, P < 0.001; HR 0.86, 95% CI: 0.77–0.95, P = 0.0044, as well as nonfatal myocardial infarction (HR 0.79, 95% CI: 0.69–0.91, P < 0.001). Meanwhile, systolic TTR was significantly associated with various cardiovascular outcomes (P ≤ 0.016) in fully-adjusted models. The diastolic TTR sustained significance in myocardial infarction when systolic blood pressure average was higher than 120 mm Hg. Conclusions In patients with diabetes, TTR of diastolic and systolic BP was independently associated with lower risks of major outcomes. The diastolic BP within the optimal target range was considerably important for reducing the risk of myocardial infarction, even when systolic BP was under stable control.

FDA approves Lodoco, the first inflammatory drug for Cardiovascular Disease. In the recent study findings, LODOCO was shown to reduce the risk of myocardial infarction, stroke, and cardiovascular death. The recently approved inflammatory drug has been shown to reduce cardiac event risk in adults with ASCVD or with multiple risk factors for cardiovascular disease by an additional 31%. These findings would certainly be helpful to various healthcare providers, like VE Healthcare, to research more and use them to fight such cardiovascular diseases. Learn more: https://lnkd.in/dMtP697a #Takeaway #pharmaceuticalcompanies #pharmaceuticalindustry #healthcareindustry #healthcareinnovation #VEHealthcaregroup #southeastasia #healthcare

Rhythm control therapy: Think sodium channel blockers! https://lnkd.in/eJBgbBQX Recent progress in AF ablation is impressive, and pulmonary vein isolation is clearly better at reducing AF burden than antiarrhythmic drugs. But not everyone is suitable for AF ablation, waiting lists are long even in high-income countries, and patients may hesitate to undergo an invasive procedure. This analysis of the EAST-AFNET 4 trial clearly shows that sodium channel blockers, mainly flecainide and propafenone, are a safe and effective rhythm control therapy in patients with atrial fibrillation and stroke risk factors, including patients with HFpEF and other cardiovascular diseases. Few side effects during long-term treatment. Read for yourself and think sodium channel blockers when AF ablation is not the treatment of first choice!"

Sodium–glucose cotransporter 2 inhibitors (SGLT2i) have noted benefits in the treatment of type 2 diabetes, cardiovascular disease, heart failure, and chronic kidney disease. Despite these benefits, the adoption of SGLT2i in clinical practice has been slow. Early initiation of SGLT2i during hospitalization has been proposed to address this gap for two important reasons: 1) it provides early clinical benefit in multiple disease states; and 2) hospitalization presents an opportunity for medication optimization and patient education, thereby overcoming clinical inertia. Challenges in SGLT2i adoption necessitate innovative strategies for integration into clinical practice. Ongoing trials and novel care delivery models are anticipated to further elucidate effective strategies for SGLT2i implementation and adherence. This review synthesizes the accrued evidence of SGLT2i across various chronic diseases. It emphasizes the rationale for early in-hospital initiation and discusses barriers and potential solutions for widespread implementation of SGLT2i in hospitalized patients