ADA Diabetes Diagnosis and Treatment Standards: Include a variety of drugs for type 1 preventive therapy to improve heart and kidney health

Recently, the American Diabetes Association (ADA) released an important update of the diagnosis and treatment standards

Include teplizumab as a preventive therapy for type 1 diabetes

Update chapter: Classification and diagnosis of diabetes

Regarding type 1 diabetes screening, the updated recommendations are as follows:

In research trials, GAD autoantibodies are recommended to screen for the risk of type 1 diabetes, or they can be considered as a screening option for first-degree family members of patients with type 1 diabetes

Before the revision, it is recommended to use a set of islet autoantibodies for screening

At the same time, this update is based on the test results of teplizumab

Recommend SGLT2 inhibitors for cardiovascular benefits

Update chapter: Cardiovascular disease and risk management

The guideline update incorporates a number of new evidence for the cardiovascular benefits of SGLT2 inhibitors, including ertugliflozin, sotagliflozin, and empagliflozin

The VERTISCV trial evaluated the effect of etogliflozin on cardiovascular outcomes in 8246 patients with type 2 diabetes and confirmed atherosclerotic cardiovascular disease (ASCVD)

Data with a median follow-up time of 3 years showed that etogliflozin had a non-inferior effect on major adverse cardiovascular events (MACE) than placebo

The SCORED trial evaluated the effects of sotagliflozin, a dual inhibitor of SGLT1 and SGLT2, on cardiovascular and renal events in patients with type 2 diabetes and moderate renal impairment

A total of 10,584 patients with type 2 diabetes, chronic kidney disease, and additional cardiovascular risks were included in the SCORED trial.

The EMPEROR-Reduced trial evaluated the effect of empagliflozin on heart failure

The trial included 3730 patients with NYHA II, III, or IV heart failure and an ejection fraction ≤40%, and 49.

Therefore, the guideline update points out: For patients with type 2 diabetes and confirmed HFrEF (decreased ejection fraction), it is recommended to use SGLT2 inhibitors that have proven beneficial in this patient population to reduce the risk of worsening heart failure and cardiovascular death

The guidelines point out that other research data are accumulating on the effects of SGLT inhibitors on hospitalized patients with acute decompensated heart failure and HFpEF (ejection fraction retention) heart failure

In the SOLOIST-WHF trial, 1,222 patients with type 2 diabetes who were recently hospitalized for worsening heart failure were randomized to receive sotagliflozin or placebo within 3 days before and after discharge

Recommend hypoglycemic drugs for patients with chronic kidney disease

Update chapter: Microvascular complications and foot management

Regarding the choice of hypoglycemic drugs for patients with chronic kidney disease, the guideline update includes new evidence affecting two drug trials, including dapagliflozin and finerenone

The DAPA-CKD trial evaluated dapagliflozin's prevention of adverse chronic kidney disease outcomes

The FIDELIO-DKD trial evaluated the renal and cardiovascular benefits of the non-steroidal selective mineralocorticoid receptor (MR) antagonist finerenone
.
In 5734 patients with type 2 diabetes with chronic kidney disease, in a median time of 2.
6 years, compared with placebo, finerenone reduced the risk of renal disease progression (renal failure, continuous decline of eGFR by at least 40%, or death from kidney disease) By 18%, the risk of the composite endpoint of cardiovascular events (death from cardiovascular causes, non-fatal myocardial infarction, non-fatal stroke, or hospitalization due to heart failure) was reduced by 14%
.

Reference

[1] Important Updates to the 2021 Standards of Medical Care in Diabetes Issued by American Diabetes Association Experts.
Retrieved June 22, 2021, from https:// to-the-2021-standards-of-medical-care-in-diabetes

[2] American Diabetes Association.
(2021).
Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes—2021.
Diabetes Care, DOI: https://doi.
org/10.
2337/dc21-S002

[3] American Diabetes Association.
(2021).
Cardiovascular Disease and Risk Management: Standards of Medical Care in Diabetes—2021.
Diabetes Care, DOI: https://doi.
org/10.
2337/dc21-S010

[4] American Diabetes Association.
(2021).
Microvascular Complications and Foot Care: Standards of Medical Care in Diabetes—2021.
Diabetes Care, DOI: https://doi.
org/10.
2337/dc21-S011