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1yr
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 with the SGLT-2 class is similar to placebo, even adding it to a diabetic who has otherwise normal glycemic control is a consideration.
  • 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 disease or chronic kidney disease.
  • 1yr
    the use of a sglt2 is a triple play for cardiorenal protection and diabetic reduction. Why wouldnt you use them first line?
  • 1yr
    I use this class a whole lot - in my type 2 diabetics - for Diabetes initially - but now for prevention of worsening of CKD, CV risk reduction and CHF. Even when their A1cs are in an optimal range because the other benefits are just so impressive
  • 1yr
    I use this class of medication to help lower sugars in my diabetic patient. With sugar control we see additional benefits in cardio-renal areas
  • 1yr
    As all Type 2 diabetics and those with CKD are at risk for Cardiovascular events I would treat all not contraindicated
  • 1yr
    patients who need that extra glycemic control, but especially with patient's with known CVD or higher risks of CVD.
  • 1yr
    patients I responded well and I am a big proponent of use of SGOT to medications providing both glycemic control cardia vascular risk reduction and renal protection
  • 1yr
    SGLT2 inhibitors are prescribed for type 2 diabetes management, particularly in patients who:

    Need additional blood glucose control.
    Have established cardiovascular disease or are at high cardiovascular risk.
    Have heart failure with reduced ejection fraction.
    Have chronic kidney disease.
    Are overweight or obese.
  • 1yr
    I am a big believer in using GLP – ones and SGLT – two medication for type two diabetes management. They’ve been extremely proven and the outcome data shows extremely good results. They are first line agents for me after Met Forman
  • 1yr
    Very important to reduce the cardiovascular risk, the SGLT-2 inhibitor and the GLP-ra are demonstrating the benefit in this population.
  • 1yr
    kerendia helps with resolving microscopic proteinuria with sglt-2
  • 1yr
    Definitely try to get diabetic patient's to agree to SGLT2 and GLP1 meds when developing microalbuminuria. Some patients are resistant to multiple meds however.
  • 1yr
    SGLT2 and GLP1 gets patient out of NIDDM and Microscopic PROTEINURIA
  • 1yr
    I usually prescribe the class as soon as pts have a new diagnosis of microalbuminuria or elevated Cr, or a new diagnosis of CHF/CAD. Most of my pts are already familiar with the medication through advertisements on TV and in magazines and agree to start the medication
  • 1yr
    excellent for reducing microalbumin and lowering glucose
  • 1yr
    SGLT-2 inhibitors came on as diabetes meds but have become the drugs for CV and Renal in wide range of settings and indicated irrespective of diabetes . Jardiance is the leader in the class and has quite robust data in CV protection and use it as the first choice for Type-2 diabetes with CAD and use Farxiga for pt with CHF given its data in prevention of CHF in diabetic pts , Farxiga initially came as the CKD drug but had the limitation to stage 3 and lower but now Jardiance is indicated for all stages of CKD and now Cardio- Renal pathologies are viewed upon as one entity and the use of these meds have become a standard of care in this disease spectrum .However the side effects of UTI's and Candidal infections need to be considered in particular in the elderly patients where BPH , Recurrent UTI , and Urinary Incontience are quite common and these meds may aggravate these conditions and risk vs benefit paradigm needs to be implemented but by and large these meds have changed the landscape of Cardio- Renal disease entities for better !!

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