Consensus document recommends discussion at follow-ups for T2D patients
Cardiologists should consider adding a glucose-lowering drug proven to have cardiovascular benefits for all their type 2 diabetes (T2D) patients, according to consensus recommendations from the American College of Cardiology (ACC).
The Expert Consensus Decision Pathway document pointed to SGLT-2 inhibitors empagliflozin (Jardiance) and canagliflozin (Invokana) and the GLP-1 receptor agonist liraglutide (Victoza) as having evidence of direct and robust improvement of cardiovascular outcomes in T2D patients with atherosclerotic cardiovascular disease (CVD). All three have a cardiovascular event prevention indication.
Clinical follow-up visits "are an ideal time to review the patient's overall management and to consider the institution of these novel agents to favorably impact patient care and outcomes," according to the recommendations released online in the Journal of the American College of Cardiology.
"A firm understanding of the net clinical benefit of these agents is important given that patients with T2D and CVD frequently follow-up with their CV [cardiovascular] specialists," it added.
"Alternatively, or in conjunction with a patient-clinician discussion, consider discussing these medications with the person caring for the patient's diabetes," the authors wrote, adding that yet another opportunity is when a T2D patient receives a diagnosis of atherosclerotic CVD or when someone with CVD gets diagnosed with T2D.
Expert Consensus Decision Pathways are the new format of ACC Expert Consensus Documents.
The document details the known benefits and potential safety concerns of SGLT-2 inhibitors and GLP-1 receptor agonists, as well as the hypothetical mechanisms underlying their CV effects. Notably, patients may not have to be on metformin before initiating these newer therapies, the authors said based on their review of the literature.
"The CV benefits of some SGLT2 inhibitors and GLP-1 receptor agonists appear robust, creating new options to improve the CV outcomes of their patients with T2D and established atherosclerotic CVD," they concluded.
Several members of the writing committee listed relationships with industry.
Journal of the American College of Cardiology
Source Reference: Das SR, et al "2018 ACC Expert Consensus Decision Pathway on novel therapies for cardiovascular risk reduction in patients with type 2 diabetes and atherosclerotic cardiovascular disease" J Am Coll Cardiol 2018; DOI: 10.1016/j.jacc.2018.09.020.
Read the original article on Medpage Today: Consider CV-Prevention Diabetes Drugs At Cardiology Visits, ACC Says