Consider SGLT2 Inhibitors for the Treatment of Type 2 Diabetes and Cardiovascular Disease

Approximately two-thirds of deaths related to type 2 diabetes are attributable to cardiovascular disease (CVD). Interventions to reduce cardiovascular risks in patients with diabetes are important. During a presentation at NAMCP 2020 Virtual Spring Managed Care Forum, Jennifer Green, MD, professor of medicine in the Division of Endocrinology, Metabolism, and Nutrition at Duke University Medical Center, discussed how the newer class of diabetes medications, sodium-glucose transport protein 2 (SGLT2) inhibitors, can have beneficial effects on CVD.

A 2020 study published in the Journal of the American Heart Association found that SGLT2 inhibitors protect against CVD and death in patients with type 2 diabetes and a history of CVD.

In addition, heart disease and chronic kidney disease are often linked, as diabetes increases the risk for both conditions. The 2020 American Diabetes Association guidelines note that among patients with type 2 diabetes who have established atherosclerotic CVD or established kidney disease, an SGLT2 inhibitor or glucagon-like peptide 1 receptor agonist with demonstrated CVD benefit is recommended as part of the glucose-lowering regimen.

Despite having anti-diabetes medications that reduce cardiovascular events, including mortality, by 15% to 25%, Dr. Green said, they are not often used. She recommended a revision of care roles where the diabetologist and cardiologist have a shared treatment responsibility, along with the primary care provider. The diabetologist would focus on blood sugar, have a vast understanding of anti-diabetes medications, and defer to the cardiologist for cardiovascular protection, while the cardiologist would focus on patient hypertension, lipids, and diet and defer to the diabetologist or primary care provider on anti-diabetes medications.

Barriers to access of these newer anti-diabetes drugs remain due to therapeutic inertia, lack of knowledge of benefits and risks, concerns about adverse events, concerns about lack of coordination with others caring for diabetes, and access, said Dr. Green.

Lastly, Dr. Green highlighted COORDINATE-Diabetes, a randomized clinical trial that will evaluate the effectiveness of implementing a clinic-level multifaceted intervention that includes establishing cardiology and diabetes care specialist partnerships, evidence-based care pathways, and measurement and feedback to improve the care of patients with type 2 diabetes and CVD. Recruitment is ongoing. Click here to learn more.

Presentation: Novel Treatment Advances and Approaches in the Management of Type 2 Diabetes: A Closer Look at the Evolving Role of SGLT2 Inhibitors. NAMCP 2020 Virtual Spring Managed Care Forum, April 16-17.