Managing Diabetes In 2015 – What to Add, When and Why? by Dr. Maria Wolf (H&S Clinical Update)
Heart and Stroke Clinical Update 2015
Concurrent Workshop F1-02
Managing Diabetes In 2015 – What to Add, When and Why
Presented by: Maria Wolfs, MD, MHSc, FRCPC (see below)
Hilton Toronto, December 2015
1. Identify patient factors that impact the addition of non-insulin pharmacotherapy in Type 2 Diabetes
2. Discuss the glycemic and cardiovascular end-point evidence among non-insulin pharmacotherapies in Type 2 Diabetes
3. Apply evidence based diabetes management to individual patient care
Patients with diabetes have a 2-3 fold increased risk of cardiovascular (CV) events and death. In general, improved glycemic control, especially when achieved early in the course of the disease, is associated with a decreased risk of CV events, specifically myocardial infarction. The choice of anti-hyperglycemic agent depends on several patient factors including degree of hyperglycemia, underlying renal function, drug coverage, risk of hypoglycemia and weight gain.
Over the last few years, several new glucose lowering agents have been approved for use in patients with diabetes.
Because the FDA requires that new glucose lower agents be evaluated for CV outcomes, several CV end -point trials have been published over the last two years with more ongoing trials scheduled to be reported over the next few years.
Glucagon-like peptide receptor agonists (GLP-1RA) are subcutaneously-delivered agents that enhance glucose-dependent insulin secretion, suppress glucagon secretion and effect appetite and gastric emptying. A CV end-point trial with Lixisenatide showed a neutral effect on CV outcomes.
DPP4-inhibitors prolong the action of endogenous GLP-1. CV outcome trials of saxagliptin, alogliptin and sitagliptin also demonstrated neutral effects on CV outcomes, although these agents may be associated with an increased risk of heart failure and pancreatitis.
SGLT-2 inhibitors block the reabsorption of glucose in the kidney, increase glucose excretion, and lower blood glucose levels. A CV outcome trial with empagliflozin showed a decrease in CV events, most notably a decrease in CV death and heart failure hospitalizations.
This workshop will work through patient cases illustrating the individual factors that impact the choice of antihyperglycemic agent while summarizing the reported CV end-point studies of the various agents
Maria Wolfs, MD, MHSc, FRCPC
Assistant Professor, University of Toronto
Staff Endocrinologist, St. Michael’s Hospital, Toronto
The following information was provided by speakers at the Clinical Update 2015. The information is intended for use by healthcare professionals for reference and education only and is not intended to be a substitute for a physician’s advice, diagnosis or treatment. You should consult your physician for personal health matters.