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Interplay between type 2 diabetes, CVD, and CKD

The metabolic, cardiac, and renal systems share a symbiotic relationship. The heart relies on the metabolic system for energy and the kidneys for volume maintenance. The kidneys rely on the heart for perfusion and the metabolic system for hormones to support function. In turn, the metabolic system depends on proper functioning of the heart and kidneys to prevent neurohormonal activation leading to insulin resistance, glycose dysregulation, and dyslipidemia.

Given this interrelationship, type 2 diabetes often coexists with CVD and CKD. Moreover, CVD and CKD in the presence of type 2 diabetes worsen each other, thereby amplifying morbidity and mortality. Accordingly, the American Diabetes Association (ADA) asserts that the treatment goal for type 2 diabetes is not only glycemic and weight management but also cardiorenal risk reduction.

The ADA recommends sodium-glucose transport protein 2 (SGLT2) inhibitors as glucose-lowering agents with proven cardiorenal benefits. Some of these agents reduce the risk of CV events in patients with type 2 diabetes and an elevated risk of CVD, although another agent in this class increases the risk of amputation. Some of the agents in this class have cardiac benefits in patients with heart failure, with or without comorbid type 2 diabetes. Several SGLT2 inhibitors in this class also have renal benefits in patients with CKD (with or without type 2 diabetes), whereas another in the class slows the progression of diabetic kidney disease.

When would you prescribe this class of medication for your patients with type 2 diabetes?

  • 1yr
    I prescribe SGLT-2 inhibitors regularly for my diabetic patients because I appreciate both the cardiac and renal benefits, in addition to the glycemic benefits. Given that the risk of hypoglycemia Show More
  • 1yr
    Given these benefits, I might consider prescribing SGLT2 inhibitors for patients who need additional glycemic control despite lifestyle modifications and other antidiabetic medications, and particularly for those with existing cardiovascular Show More

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Micronutrient Patterns and Low Intake of Vitamin A, Vitamin D, Folate, Magnesium, and Potassium Among Prediabetes and Type 2 Diabetes Patients

Micronutrient Patterns and Low Intake of Vitamin A, Vitamin D, Folate, Magnesium, and Potassium Among Prediabetes and Type 2 Diabetes Patients

Source : https://pubmed.ncbi.nlm.nih.gov/38800767/

Background Assessing micronutrient intake is important in identifying deficiencies that may contribute to insulin resistance, poor glycemic control, and increased risk of diabetes-related complications. The study's objectives were to evaluate...

he Vit.B2-P-Vit.B12 pattern was significantly linked to WC, body mass index (BMI), BF, FPG, and serum insulin (SI). For the T2DM patients, the K-Folate-Mg pattern displayed an inverse and significant association with weight and WC. The Iron-Se-Vit.B3 pattern showed a significant association with low-density lipoprotein (LDL) cholesterol,...

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BCAA-nitrogen flux in brown fat controls metabolic health independent of thermogenesis

BCAA-nitrogen flux in brown fat controls metabolic health independent of thermogenesis

Source : https://pubmed.ncbi.nlm.nih.gov/38653240/

Brown adipose tissue (BAT) is best known for thermogenesis. Rodent studies demonstrated that enhanced BAT thermogenesis is tightly associated with increased energy expenditure, reduced body weight, and improved glucose homeostasis....

A high-fat diet attenuated BCAA-nitrogen flux and metabolite synthesis in BAT, whereas cold-activated BAT enhanced the synthesis. This work uncovers a metabolite-mediated pathway through which BAT controls metabolic health beyond thermogenesis.

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Sodium-Glucose Cotransport Protein 2 Inhibitors in Patients With Type 2 Diabetes and Acute Kidney Disease

Source : https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2813460?resultClick=3

In this cohort study of patients with type 2 diabetes and AKD, administration of SGLT-2is was associated with a significant reduction in all-cause mortality, MAKEs, and MACEs when compared with nonuse, underscoring the importance of SGLT-2is in care after acute kidney injury. These findings emphasize the potential benefits of SGLT-2is in...

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1yr

Growth Hormone Mediators and Glycemic Control in Youths With Type 2 Diabetes

Source : https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2815640?resultClick=3

This study suggests that changes in plasma growth hormone mediators are associated with loss of glycemic control in youth-onset T2D, with IGF-1 associated with lower risk and GHR and IGFBP-1 associated with increased risk.