Evolving evidence-based recommendations in T2D | ACROSS T2D

Evolving evidence-based recommendations in T2D

This module summarises recent changes to global diabetes, cardiovascular disease, heart failure and kidney disease guidelines and updated label indications as a result of cardiovascular outcome trials (CVOTs) and cardiorenal trials.

Evolving evidence-based recommendations in T2D

Evolving evidence-based recommendations in T2D
Evolving evidence-based recommendations in T2D
Login or create an account to see restricted content
Patients with T2D have multiple risk factors that contribute to Cardio-Renal-Metabolic (CRM) diseases
Login or create an account to see restricted content
The cardiovascular-renal-metabolic aspects of T2D should be addressed by a holistic approach across the continuum
Login or create an account to see restricted content
Reductions in CV, HF and kidney outcomes observed with SGLT2 inhibitors in patients with T2D
Login or create an account to see restricted content
Evidence from CVOTs in patients with T2D and with/without CV disease has shown that GLP-1 RAs have beneficial effects on CV and kidney outcomes
Login or create an account to see restricted content
Since 2016, guidelines and societies have been recommending the use of SGLT2 inhibitors and/or GLP-1 RAs for their CRM benefits
Login or create an account to see restricted content
Evolving evidence-based recommendations in T2D
Login or create an account to see restricted content
Navigation guide
Login or create an account to see restricted content
Summary slide by patient types: Current guidelines recommend SGLT2 inhibitors and/or GLP-1 RAs for several types of patients with T2D
Login or create an account to see restricted content
Summary slide by guidelines: Current guidelines recommend SGLT2 inhibitors and/or GLP-1 RAs for several types of patients with T2D
Login or create an account to see restricted content
Evolving evidence-based recommendations in T2D
Login or create an account to see restricted content
ADA guidelines have evolved to recommend SGLT2 inhibitors and GLP-1 RAs with proven CV and kidney benefits in patients with T2D and cardio–renal comorbidities (1/5)
Login or create an account to see restricted content
The 2021 ADA guidelines emphasise the importance of CV disease risk management in T2D (2/5)
Login or create an account to see restricted content
The 2021 ADA guidelines recognise HF as an important type of CV disease to consider when determining optimal T2D treatment (3/5)
Login or create an account to see restricted content
The 2021 ADA guidelines recommend the use of glucose-lowering agents with proven CV/kidney benefit in patients with T2D and kidney disease (4/5)
Login or create an account to see restricted content
The 2021 ADA guidelines recommend the use of an SGLT2i or GLP-1 RA to reduce the risk of CV events or CKD progression in patients with T2D (5/5)
Login or create an account to see restricted content
The 2019 ADA–EASD consensus statement recommends that choice of second-line therapy in patients with T2D should be initially based upon assessment of established ASCVD, CKD or HF (1/2)
Login or create an account to see restricted content
In the 2019 ADA–EASD consensus statement, glucose-lowering agents with proven CV benefits are recommended preferentially in addition to metformin therapy in patients with T2D (2/2)
Login or create an account to see restricted content
The 2020 AACE/ACE algorithm acknowledges that certain SGLT2 inhibitors and GLP-1 RAs have CV and possible kidney benefits in patients with T2D
Login or create an account to see restricted content
Evolving evidence-based recommendations in T2D
Login or create an account to see restricted content
The ACC ECDP provides guidance to CV specialists and diabetes care providers who jointly manage patients with T2D and ASCVD, HF and/or DKD (1/5)
Login or create an account to see restricted content
The 2020 ACC ECDP recommends the use of SGLT2 inhibitors or GLP-1 RAs with proven CV benefit in patients with T2D based on cardio–renal comorbidities (2/5)
Login or create an account to see restricted content
The 2020 ACC ECDP discusses SGLT2 inhibitor use to manage patients with T2D and at least one of the following: ASCVD, HF, DKD or high risk for ASCVD (3/5)
Login or create an account to see restricted content
The 2020 ACC ECDP discusses GLP-1 RA use to manage patients with T2D and at least one of the following: of ASCVD or high risk for ASCVD (4/5)
Login or create an account to see restricted content
The 2020 ACC ECDP discusses opportunities to initiate SGLT2 inhibitors or GLP‑1 RAs with demonstrated CV or kidney benefits in patients with T2D* (5/5)
Login or create an account to see restricted content
The 2019 ACC–AHA guidelines recommend considering initiation of SGLT2 inhibitors or GLP-1 RA with proven CV benefit for the treatment of T2D to reduce CV disease risk
Login or create an account to see restricted content
The ESC recognise the paradigm shift in glucose-lowering treatment following recent CVOTs (1/3)
Login or create an account to see restricted content
The 2019 ESC guidelines recommend glucose‑lowering therapies with proven CV benefit in patients with T2D and ASCVD or very high/high CV risk (2/3)
Login or create an account to see restricted content
The 2019 ESC guidelines recommend glucose‑lowering therapies with proven CV benefit in patients with diabetes and ASCVD or very high/high CV risk (3/3)
Login or create an account to see restricted content
Evolving evidence-based recommendations in T2D
Login or create an account to see restricted content
The 2020 CCS/CHFS guidelines recommend the use of SGLT2 inhibitors in patients with T2D and cardio–renal comorbidities
Login or create an account to see restricted content
The 2019 ESC guidelines recommend SGLT2 inhibitors to lower the risk of HF hospitalisation in patients with T2D
Login or create an account to see restricted content
The 2019 ACC ECDP (HHF) provide considerations for initiation of an SGLT2 inhibitor and monitoring patients with T2D hospitalised for HF
Login or create an account to see restricted content
Evolving evidence-based recommendations in T2D
Login or create an account to see restricted content
The 2019 ERA-EDTA consensus statement recommends an SGLT2 inhibitor with CV and kidney benefits after first-step treatment in patients with T2D and CKD not on HbA1c target (1/2)
Login or create an account to see restricted content
The 2019 ERA-EDTA consensus statement includes recommendations for SGLT2 inhibitors and GLP-1 RAs in patients with T2D and CKD on HbA1c target after first-step treatment or combination treatment (2/2)
Login or create an account to see restricted content
2019 ESC guidelines recommend SGLT2 inhibitors in patients with T2D to lower the risk of kidney endpoints in patients with an eGFR of 30 to <90 ml/min/1.73 m²
Login or create an account to see restricted content
2020 KDIGO guidelines recommend comprehensive treatment of patients with T2D and CKD to reduce risks of kidney disease progression and CV disease (1/4)
Login or create an account to see restricted content
Lifestyle therapy in addition to first-line therapy is the cornerstone of glycaemic management for patients with T2D and CKD (2/4)
Login or create an account to see restricted content
The 2020 KDIGO guideline recommendations place a high value on CV and kidney benefits for the treatment of patients with T2D and CKD (3/4)
Login or create an account to see restricted content
The 2020 KDIGO guidelines provide recommendations on SGLT2 inhibitor use in clinical practice for patients with T2D and CKD (4/4)
Login or create an account to see restricted content
Evolving evidence-based recommendations in T2D
Login or create an account to see restricted content
2017 IDF primary care guidelines provide recommendations for choice of glucose-lowering agent in patients with T2D and established CV disease
Login or create an account to see restricted content
2020 PCDE statement recommends certain glucose-lowering agents for patients with T2D at very high CV risk¹ (1/2)
Login or create an account to see restricted content
2020 PCDE statement recommends certain glucose-lowering agents for patients with T2D at high CV risk, including patients who are overweight/obese¹ (2/2)
Login or create an account to see restricted content
Evolving evidence-based recommendations in T2D
Login or create an account to see restricted content
FDA and EU label indications for empagliflozin after the EMPA-REG OUTCOME trial
Login or create an account to see restricted content
FDA and EU label indications for canagliflozin after the CANVAS Program and CREDENCE trial
Login or create an account to see restricted content
FDA and EU label indications for dapagliflozin
Login or create an account to see restricted content
FDA and EU label indications for ertugliflozin
Login or create an account to see restricted content
FDA and EU label indications for liraglutide after the LEADER trial
Login or create an account to see restricted content
FDA and EU label indications for injectable semaglutide after the SUSTAIN-6 trial
Login or create an account to see restricted content
FDA label indication for oral semaglutide after the PIONEER 6 trial
Login or create an account to see restricted content
FDA and EU label indication for dulaglutide after the REWIND trial
Login or create an account to see restricted content
Evolving evidence-based recommendations in T2D
Login or create an account to see restricted content
Understanding clinical guidelines: summary
Login or create an account to see restricted content
Back-up
Login or create an account to see restricted content
ESC Guidelines on diabetes, pre-diabetes and CV diseases – 2019
Login or create an account to see restricted content
2020 PCDE statement includes new evidence-based criteria for CV risk stratification of patients with T2D in primary care¹
Login or create an account to see restricted content
ADA evidence-grading system – 2021
Login or create an account to see restricted content
The 2019 ESC guidelines recommend glucose‑lowering therapies in patients with diabetes and with ASCVD, or very high/high CV risk, HF risk, CKD, or CKD risk
Login or create an account to see restricted content
ESC 2019 Guidelines on diabetes, pre-diabetes and CV diseases: evidence-grading system
Login or create an account to see restricted content
ACC-AHA evidence-grading system – 2019
Login or create an account to see restricted content
The 2020 AACE/ACE algorithm recognises the CV and kidney benefits of SGLT2 inhibitors in patients with T2D
Login or create an account to see restricted content
The 2020 AACE/ACE algorithm recognises the CV and kidney benefits of certain GLP-1 RAs in patients with T2D