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2 . 2021

Management of cardiorenal risks in patients with type 2 diabetes mellitus

Abstract

This clinical case demonstrates the benefits of using the sodium-glucose cotransporter type 2 inhibitor empagliflozin in combination therapy with metformin in a patient with type 2 diabetes mellitus and high cardiovascular and renal risks in routine clinical practice. The presented data on the dynamic control of weight, visceral fat level according to bioimpedance, blood pressure, carbohydrate, lipid, purine metabolism, and the marker of adipose tissue activity leptin show the importance of changing the paradigm of treatment of type 2 diabetes from a glucose-centric model to a multifactorial management of cardio-renal and metabolic risks.

Keywords:type 2 diabetes mellitus, cardiorenal continuum, sodium-glucose cotransporter type 2 inhibitors, empagliflozin, EMPA-REG OUTCOME

Funding. The study had no sponsor support.

Conflict of interest. The authors declare no conflict of interest.

For citation: Ametov A.S., Pyanykh O.P., Depyui T.I. Management of cardiorenal risks in patients with type 2 diabetes mellitus. Endokrinologiya: novosti, mneniya, obuchenie [Endocrinology: News, Opinions, Training]. 2021; 10 (2): 105-11. DOI: https://doi.org/10.33029/2304-9529-2021-10-2-105-111 (in Russian)

REFERENCES

1. Emerging Risk Factors Collaboration; Sarwar N., Gao P., et al. Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies. Lancet. 2010; 375: 2215-22.

2. Khan S.S., Butler J., Gheorghiade M. Management of comorbid diabetes mellitus and worsening heart failure. JAMA. 2014; 311: 2379-80.

3. Swoboda PP, McDiarmid A.K., Erhayiem B., et al. Diabetes mellitus, microalbuminuria, and subclinical cardiac disease: identification and monitoring of individuals at risk of heart failure. J Am Heart Assoc. 2017; 6: e005539.

4. Mahaffey K.W., Neal B., Perkovic V., et al. Canagliflozin for primary and secondary prevention of cardiovascular events: results from the CANVAS Program (Canagliflozin Cardiovascular Assessment Study). Circulation. 2018; 137: 323-34.

5. Wiviott S.D., Raz I., Bonaca M.P., et al. Dapagliflozin and cardiovascular outcomes in type 2 diabetes. N Engl J Med. 2019; 380: 347-57.

6. Zinman B., Wanner C., Lachin J.M., et al. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Engl J Med. 2015; 373: 2117-28.

7. Heerspink H.J., Perkins B.A., Fitchett D.H., Husain M., Cherney D.Z. Sodium glucose cotransporter 2 inhibitors in the treatment of diabetes mellitus: cardiovascular and kidney effects, potential mechanisms, and clinical applications. Circulation. 2016; 134: 752-72. DOI: https://doi.org/10.1161/CIRCULATIONAHA.116.021887

8. Ferreira J.P., Fitchett D., Ofstad A.P., et al. Empagliflozin for patients with presumed resistant hypertension: a post hoc analysis of the EMPA-REG OUTCOME trial. Am J Hypertens. 2020; 33 (12): 1092-101. DOI: https://doi.org/10.1093/ajh/hpaa073

9. Bailey C.J. Uric acid and the cardio-renal effects of SGLT2 inhibitors. Diabetes Obes Metab. 2019; 21 (6): 1291-8. DOI: https://doi.org/10.1111/dom.13670

10. Verma S., Ji Q., Bhatt D.L., et al. The association between uric acid levels and cardiorenal outcomes and death in patients with type 2 diabetes: a sub-analysis of EMPA-REG OUTCOME. In: American College of Cardiology 68th Annual Scientific Session. New Orleans, LA, 2019: 1134-445.

11. Inzucchi S.E., Zinman B., Fitchett D., et al. How does empagliflozin reduce cardiovascular mortality? Insights from a mediation analysis of the EMPA-REG OUTCOME trial. Diabetes Care. 2018; 41: 356-63.

12. Packer M. Do sodium-glucose co-transporter-2 inhibitors prevent heart failure with a preserved ejection fraction by counterbalancing the effects of leptin? A novel hypothesis. Diabetes Obes Metab. 2018; 20: 1361-6.

13. Inzucchi S.E., Bergenstal R.M., Buse J.B., et al. Management of hyperglycaemia in type 2 diabetes, 2015: a patient-centred approach. In: Update to a position statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetologia. 2015; 58: 429-42. PMID: 25583541.

14. American Diabetes Association. Diabetes Care. 2021; 44 (suppl 1): S 73-84. DOI: https://doi.org/10.2337/dc21-S006

15. Schernthaner G., Shehadeh N., Ametov A.S., et al. Worldwide inertia to the use of cardiorenal protective glucose-lowering drugs (SGLT2i and GLP-1 RA) in high-risk patients with type 2 diabetes. Cardiovasc Diabetol. 2020; 19: 185. DOI: https://doi.org/10.1186/s12933-020-01154-w

16. Standards of specialized diabetes care. Edited by Dedov I.I., Shestakova M.V., Mayorov A. Yu. 9th edition, suppl. Moscow, 2019. DOI: https://doi.org/10.14341/DM221S1 (in Russian)

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CHIEF EDITOR
CHIEF EDITOR
Ametov Alexander S.
Honored Scientist of the Russian Federation, Doctor of Medical Sciences, Professor, Head of Subdepartment of Endocrinology, Head of the UNESCO Network Chair on the subject «Bioethics of diabetes as a global problem» of the Russian Medical Academy of Continuous Professional Education (Moscow)
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