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The residual cardiorenal risk in type 2 diabetes

Dario Giugliano1,2, Maria Ida Maiorino3, Giuseppe Bellastella4

  • 1Division of Endocrinology and Metabolic Diseases, Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy. dario.giugliano@unicampania.it.

Cardiovascular Diabetology
|February 6, 2021
PubMed

Insights

Newer diabetes drugs like SGLT-2 inhibitors significantly reduce cardiorenal risk in type 2 diabetes (T2D) patients. While optimal glycemic control offers some benefit, SGLT-2 inhibitors provide greater protection against heart failure and kidney disease progression.

Area of Science:

  • Cardiology
  • Nephrology
  • Endocrinology

Background:

  • Type 2 diabetes (T2D) management involves addressing cardiorenal risks.
  • Optimal glycemic control and newer antihyperglycemic drugs impact cardiovascular events and diabetic kidney disease (DKD).

Purpose of the Study:

  • To introduce and analyze the concepts of removed and residual cardiorenal risks in T2D patients.
  • To evaluate the effectiveness of glycemic control and specific antihyperglycemic drugs in mitigating cardiorenal risks.

Main Methods:

  • Review of intensive glucose lowering trials (IGT) and cardiovascular outcome trials (CVOT).
  • Analysis of risk reduction data for major adverse cardiovascular events (MACE), heart failure (HF), and DKD progression.
  • Comparison of glucagon-like peptide-1 receptor agonists (GLP-1RA) and sodium-glucose transporter-2 inhibitors (SGLT-2i).

Main Results:

  • Optimal glycemic control removed 9% of MACE risk, 20% of DKD risk, and 0% of HF risk.
  • GLP-1RA removed 13% of MACE risk, while SGLT-2i removed 12%.
  • SGLT-2i demonstrated superior risk removal for kidney outcomes (39% vs 17%) and HF (33% vs 9%) compared to GLP-1RA.
  • Dipeptidyl peptidase-4 inhibitors showed minimal cardiorenal benefits with high residual risks.

Conclusions:

  • SGLT-2 inhibitors offer substantial cardiorenal protection in T2D patients, exceeding that of GLP-1RA for specific outcomes.
  • Residual cardiorenal risk remains significant with certain treatments, highlighting the need for further research.
  • The additive effect of newer antihyperglycemic drugs and optimal glycemic control requires investigation through randomized controlled trials.

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