Learn from an expert: How to limit cardiovascular disease among patients with diabetes
As the list of available Type 2 diabetes (T2D) medications continues to grow, healthcare providers and patients alike may find themselves feeling overwhelmed. Rita Rastogi Kalyani, MD, an endocrinologist and associate professor at Johns Hopkins Medicine, has crafted a new analysis aimed at addressing that potential confusion by recommending ways to reduce the risk of cardiovascular disease among patients with T2D.
“We’ve seen a major shift in diabetes care over the past few years,” Kalyani said in a prepared statement from Johns Hopkins. “We now have tools to better understand how to reduce both microvascular and macrovascular complications in people with T2D.”
Kalyani’s assessment, published in full in the New England Journal of Medicine, is presented as a clinical practice review, meaning it opens with a quick case study and then reviews the various ways a provider may treat the patient in question.
One of the first points Kalyani makes is just how much information goes into evaluating a patient with T2D. Clinicians must evaluate the individual’s lifestyle, for instance, while also keeping an eye out for any key risk factors and going over their entire medical history. And once that evaluation is complete, Kalyani adds, the clinician must remember to embrace shared decision-making at all times.
Providing a detailed review of numerous T2D medications, Kalyani noted that both GLP-1 receptor agonists and SGLT2 inhibitors stand as effective ways to limit a patient’s risk of experiencing a major cardiovascular event.
“After metformin, which is widely considered the initial drug treatment for type 2 diabetes, specific drugs in the GLP-1 receptor agonist and SGLT2 inhibitor classes with demonstrated cardiovascular benefit should be considered as additional medications for patients who already have cardiovascular disease,” she said in the same statement. “This should be done irrespective of whether their A1C level is at target to reduce the risk of future cardiovascular events.”
Kalyani formatted her analysis with detailed tables, making it as easy as possible for providers to compare the benefits and potential adverse effects associated with various medications. She also noted that multiple professional organizations have shared their own recommendations that cover this subject.
“The guidelines are generally concordant with each other, with relatively minor differences with respect to guidance for high-risk patients, the specific glucose-lowering agents recommended, and glycemic targets,” she wrote in the NEJM review. “Most organizations and societies endorse the use of metformin as first-line therapy for type 2 diabetes.”
Click here for her full clinical practice review.
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.