Comprehensive Management of Cardiovascular Risk Factors for Adults With Type 2 Diabetes: A Scientific Statement From the American Heart Association

Joseph, Joshua J.; Deedwania, Prakash; Acharya, Tushar; Aguilar, David; Bhatt, Deepak L.; Chyun, Deborah; Palo, Katherine E. Di; Golden, Sherita Hill; Sperling, Laurence

doi:10.1161/cir.0000000000001040

Cited by 271 publications

(254 citation statements)

References 331 publications

(455 reference statements)

Supporting

Mentioning

194

Contrasting

Unclassified

Order By: Relevance

“…Why is there such a large gap? Although, SGLT-2i with GLP-1 RAs in diabetic patients, especially those with ASCVD, are recommended by several guidelines ( 2 – 6 ), they are expensive and many patients, especially those without medical insurance, are restricted. Moreover, since China is currently implementing a Diagnosis Related Groups (DRG) payment policy, the conditions for medical insurance reimbursement for the use of GLP-1RAs or SGLT-2i are relatively strict, which also greatly limits the use in patients with medical insurance.…”

Section: Discussionmentioning

confidence: 99%

“…Atherosclerotic cardiovascular disease (ASCVD)-defined as coronary heart disease (CHD), cerebrovascular disease, or peripheral arterial disease presumed to be of atherosclerotic origin-is the leading cause of morbidity and mortality in individuals with diabetes ( 2 – 4 ). Glycemic control alone has a limited role in reducing the risk of ASCVD and the integrated management of multiple risk factors such as glycemia, blood pressure, lipids, and obesity, as well as the combination of appropriate antiplatelet therapy is crucial to minimize the risk of cardiovascular events and mortality ( 3 , 5 , 6 ).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Gaps of Medication Treatment Management Between Guidelines and Real-World for Inpatients With Type 2 Diabetes in China From Pharmacist’s Perspective

et al. 2022

View full text Add to dashboard Cite

BackgroundThe prevalence of diabetes mellitus remains high in China, and more cardiovascular and cerebrovascular adverse events due to diabetes mellitus are likely to occur in the future.ObjectiveTo analyze the gap between the current pharmacotherapy management and the guidelines for inpatients with type 2 diabetes mellitus from the perspective of pharmacists so as to provide a reference for optimal pharmacotherapy management methods and models for patients with type 2 diabetes mellitus.MethodsThe study was a cross-sectional observational study. The study was conducted by investigating and analyzing the use of glucose-lowering drugs, adjustment of blood pressure management strategy, lipid management, weight management, and application of antiplatelet drugs in type 2 diabetes inpatients.ResultsA total of 1086 patients with type 2 diabetes were included. Metformin, glycosidase inhibitors, and basal insulin were the most used among type 2 diabetes inpatients. The use of SGLT-2, GLP-1 RAs, DPP-4, and metformin all showed significant increase. SGLT-2 inhibitors (SGLT-2i) showed the fastest increase from 2020 to 2021 (14.5% vs. 39.6%); However, the application rate of SGLT-2i was low among patients with combined ASCVD, renal insufficiency, and diabetic nephropathy (46.4%, 40.9%, and 45.8% respectively). For patients with substandard blood pressure at admission, the average rate of intervention by endocrinologists for adjusting the antihypertensive regimen during hospitalization was 55.6%, and the application rate of ACEI/ARB drugs reached 64.4%. The application rate of statins among patients with type 2 diabetes was still relatively high, at 78.8%. However, the overall intervention rate for patients with suboptimal LDL-c was only 24.1%. The application rate of antiplatelet agents for patients with ASCVD was 77.6%, which was higher than that for patients without ASCVD.ConclusionThere is still a gap between the practice of medication treatment management of Chinese inpatients with type 2 diabetes and the guidelines, especially in the application of GLP-1RAs and SGLT-2i in patients with concomitant ASCVD, diabetic nephropathy, and renal insufficiency. Meanwhile, physicians and pharmacists should pay more attention on achieving blood pressure and LDL-c standards in type 2 diabetic patients and provide timely interventions.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Gaps of Medication Treatment Management Between Guidelines and Real-World for Inpatients With Type 2 Diabetes in China From Pharmacist’s Perspective

et al. 2022

View full text Add to dashboard Cite

show abstract

“…Different scientific societies recommend the use of antidiabetic therapies in CVD, including the AHA [ 39 ], the ADA [ 91 ], the ESC [ 41 ] and the ESC/EASD [ 40 ]; Chinese scientific bodies, however, do not [ 92 ]. The overall medication regimen is roughly similar, with a key focus on metformin, GLP-1 agonists and SGLT2 inhibitors in guidelines for treating CVD in T2DM patients (Table 5 ).…”

Section: Current Recommendations On the Use Of Antidiabetic Drugs Wit...mentioning

confidence: 99%

“…The presence of hypertension in patients with T2DM significantly increases the risk of CVD development, and a study revealed that evaluated blood pressure down to < 120 mm Hg and < 70 mm Hg could decrease mortality, macrovascular, and microvascular events regardless of baseline systolic blood pressure [ 39 ]. Thus, lowering blood pressure reduces CVD events and microvascular complications and has a favorable effect on CVD outcomes in patients with and without T2DM.…”

Section: Hypertensionmentioning

confidence: 99%

See 1 more Smart Citation

Cardiovascular disease in type 2 diabetes mellitus: progress toward personalized management

Guan

et al. 2022

Cardiovasc Diabetol

137

View full text Add to dashboard Cite

Cardiovascular diseases (CVDs) are the main cause of death among patients with type 2 diabetes mellitus (T2DM), particularly in low- and middle-income countries. To effectively prevent the development of CVDs in T2DM, considerable effort has been made to explore novel preventive approaches, individualized glycemic control and cardiovascular risk management (strict blood pressure and lipid control), together with recently developed glucose-lowering agents and lipid-lowering drugs. This review mainly addresses the important issues affecting the choice of antidiabetic agents and lipid, blood pressure and antiplatelet treatments considering the cardiovascular status of the patient. Finally, we also discuss the changes in therapy principles underlying CVDs in T2DM.

show abstract

Coordinated Care to Optimize Cardiovascular Preventive Therapies in Type 2 Diabetes

Pagidipati

Nelson

Kaltenbach

et al. 2023

JAMA

View full text Add to dashboard Cite

ImportanceEvidence-based therapies to reduce atherosclerotic cardiovascular disease risk in adults with type 2 diabetes are underused in clinical practice.ObjectiveTo assess the effect of a coordinated, multifaceted intervention of assessment, education, and feedback vs usual care on the proportion of adults with type 2 diabetes and atherosclerotic cardiovascular disease prescribed all 3 groups of recommended, evidence-based therapies (high-intensity statins, angiotensin-converting enzyme inhibitors [ACEIs] or angiotensin receptor blockers [ARBs], and sodium-glucose cotransporter 2 [SGLT2] inhibitors and/or glucagon-like peptide 1 receptor agonists [GLP-1RAs]).Design, Setting, and ParticipantsCluster randomized clinical trial with 43 US cardiology clinics recruiting participants from July 2019 through May 2022 and follow-up through December 2022. The participants were adults with type 2 diabetes and atherosclerotic cardiovascular disease not already taking all 3 groups of evidence-based therapies.InterventionsAssessing local barriers, developing care pathways, coordinating care, educating clinicians, reporting data back to the clinics, and providing tools for participants (n = 459) vs usual care per practice guidelines (n = 590).Main Outcomes and MeasuresThe primary outcome was the proportion of participants prescribed all 3 groups of recommended therapies at 6 to 12 months after enrollment. The secondary outcomes included changes in atherosclerotic cardiovascular disease risk factors and a composite outcome of all-cause death or hospitalization for myocardial infarction, stroke, decompensated heart failure, or urgent revascularization (the trial was not powered to show these differences).ResultsOf 1049 participants enrolled (459 at 20 intervention clinics and 590 at 23 usual care clinics), the median age was 70 years and there were 338 women (32.2%), 173 Black participants (16.5%), and 90 Hispanic participants (8.6%). At the last follow-up visit (12 months for 97.3% of participants), those in the intervention group were more likely to be prescribed all 3 therapies (173/457 [37.9%]) vs the usual care group (85/588 [14.5%]), which is a difference of 23.4% (adjusted odds ratio [OR], 4.38 [95% CI, 2.49 to 7.71]; P &lt; .001) and were more likely to be prescribed each of the 3 therapies (change from baseline in high-intensity statins from 66.5% to 70.7% for intervention vs from 58.2% to 56.8% for usual care [adjusted OR, 1.73; 95% CI, 1.06-2.83]; ACEIs or ARBs: from 75.1% to 81.4% for intervention vs from 69.6% to 68.4% for usual care [adjusted OR, 1.82; 95% CI, 1.14-2.91]; SGLT2 inhibitors and/or GLP-1RAs: from 12.3% to 60.4% for intervention vs from 14.5% to 35.5% for usual care [adjusted OR, 3.11; 95% CI, 2.08-4.64]). The intervention was not associated with changes in atherosclerotic cardiovascular disease risk factors. The composite secondary outcome occurred in 23 of 457 participants (5%) in the intervention group vs 40 of 588 participants (6.8%) in the usual care group (adjusted hazard ratio, 0.79 [95% CI, 0.46 to 1.33]).Conclusions and RelevanceA coordinated, multifaceted intervention increased prescription of 3 groups of evidence-based therapies in adults with type 2 diabetes and atherosclerotic cardiovascular disease.Trial RegistrationClinicalTrials.gov Identifier: NCT03936660

show abstract

Comprehensive Management of Cardiovascular Risk Factors for Adults With Type 2 Diabetes: A Scientific Statement From the American Heart Association

Cited by 271 publications

References 331 publications

Gaps of Medication Treatment Management Between Guidelines and Real-World for Inpatients With Type 2 Diabetes in China From Pharmacist’s Perspective

Gaps of Medication Treatment Management Between Guidelines and Real-World for Inpatients With Type 2 Diabetes in China From Pharmacist’s Perspective

Cardiovascular disease in type 2 diabetes mellitus: progress toward personalized management

Coordinated Care to Optimize Cardiovascular Preventive Therapies in Type 2 Diabetes

Contact Info

Product

Resources

About