WASHINGTON: Two newer groups of medications prescribed primarily for Type 2 diabetes treatment (SGLT2 inhibitors and GLP-1 receptor agonists) could significantly reduce risks associated with chronic kidney disease (CKD) and heart disease.
Based on analyses of the clinical trials through March 2020, a group of leading experts in diabetes, heart failure, kidney disease and cardiometabolic disease believe the medicines should be considered for people with CKD and type 2 diabetes to protect against heart and kidney disease and their serious complications, according to a new Scientific Statement from the American Heart Association, ‘Cardiorenal Protection With the Newer Antidiabetic Agents in Patients With Diabetes and Chronic Kidney Disease,’ published today in the AHA’s flagship journal, Circulation.
The statement reviews evidence from multiple, large, international, randomized controlled trials of two classes of blood sugar control medications — sodium-glucose co-transporter 2 (SGLT2) inhibitors and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) — in patients with Type 2 diabetes, chronic kidney disease and those who were either at risk for or already had cardiovascular disease. The composite results of the trials found that SGLT2 inhibitors and GLP-1 RAs can safely and significantly reduce the risk of cardiovascular events and death, reduce hospitalization and slow the progression of chronic to end-stage kidney disease including the risks of dialysis, transplantation or death.
“A collaborative treatment approach among primary care doctors and specialists in diabetes, cardiology and kidney disease that, when indicated, includes treatment with these two classes of medications could add more heart- and kidney disease-free years and greatly extend survival for people with Type 2 diabetes,” said chair of the statement writing committee Janani Rangaswami, M.D., FACP, FAHA, associate chair of research in the department of medicine at Einstein Medical Center and associate clinical professor at the Sidney Kimmel College of Thomas Jefferson University, both in Philadelphia.
Chronic kidney disease (CKD) is a common long-term complication of Type 2 diabetes and represents a major public health problem in the U.S. The two leading causes of chronic kidney disease are Type 2 diabetes and hypertension. There are 26 million people in the U.S. diagnosed with diabetes and an additional 9.45 million are undiagnosed. In the U.S., 108 million (45%) adults have hypertension (130/80 mmHg or higher) or are taking blood pressure medications. An estimated 37 million American adults have kidney disease.
Most patients with end-stage kidney disease have Type 2 diabetes, and people with Type 2 diabetes are at increased risk for high blood pressure, cardiovascular disease (CVD) including heart attacks and heart failure, and stroke. Although there are established standards of care, a disproportionately high burden of kidney and cardiovascular disease exists in this population, leading to concerning levels of avoidable death, illness and health care costs, as well as poor quality of life.
The scientific statement provides detailed, practical guidance for health care professionals to recognize and treat patients who may benefit from SGLT2 inhibitor and GLP-1 RA medications.
Recent studies show these newer medications are not widely prescribed, especially among patients with higher risks for cardiovascular disease and chronic kidney disease. A recent nationwide study of over one million commercially insured and Medicare Advantage adult beneficiaries showed that 7% of patients with Type 2 diabetes were treated with an SGLT2 inhibitor medication. (ANI)