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3 . 2021

Multifactorial management of type 2 diabetes mellitus in patients with very high cardiovascular risk

Abstract

This clinical case demonstrates the advantages of correcting hypoglycemic therapy with a risk of hypoglycemia in a patient with type 2 diabetes mellitus who suffered an acute cerebrovascular accident and initiating therapy with cardiovascular-renal benefits. Triple combination therapy with a sodium-glucose cotransporter 2 inhibitor empagliflozin, biguanide metformin and a dipeptidyl peptidase-4 inhibitor linagliptin demonstrated an improvement in glycemic control according to outpatient glycemic profile data obtained using the FreeStyle Libre continuous glucose monitoring system. In addition, according to the results of multinational randomized double-blind placebo-controlled clinical trials of EMPA-REG OUTCOME, CARMELINA and CAROLINA, the use of empagliflozin and linagliptin in the management of type 2 diabetes mellitus has a number of advantages in patients with very high cardiovascular risk.

Keywords:type 2 diabetes mellitus, SGLT-2 inhibitor, empagliflozin, DPP-4 inhibitor, linagliptin, EMPA-REG OUTCOME, CARMELINA, CAROLINA

Funding. The study had no sponsor support.
Conflict of interest. The author declares no conflict of interest.
For citation: Pyanykh O.P. Multifactorial management of type 2 diabetes mellitus in patients with very high cardiovascular risk. Endokrinologiya: novosti, mneniya, obuchenie [Endocrinology: News, Opinions, Training]. 2021; 10 (3): 75-81. DOI: https://doi.org/10.33029/2304-9529-2021-10-3-75-81 (in Russian)

REFERENCES

1. Rawshani A., Rawshani A., Franzén S., et al. Mortality and cardiovascular disease in type 1 and type 2 diabetes. N Engl J Med. 2017; 376: 1407–18.

2. Lau L., Lew J., Borschmann K., et al. Prevalence of diabetes and its effects on stroke outcomes: a meta-analysis and literature review. J Diabetes Investig. 2019; 10 (3): 780–92. DOI: https://doi.org/10.1111/jdi.12932

3. O’Donnell M.J., Chin S.L., Rangarajan S., et al. Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE): a case-control study. Lancet. 2016; 388: 761–75.

4. Gray C.S., Scott J.F., French J.M., et al. Prevalence and prediction of unrecognised diabetes mellitus and impaired glucose tolerance following acute stroke. Age Ageing. 2004; 33: 71–7.

5. Zahra F., Kidwai S.S., Siddiqi S.A., et al. Frequency of newly diagnosed diabetes mellitus in acute ischaemic stroke patients. J Coll Physicians Surg Pak. 2012; 22: 226–9.

6. Eriksson M., Carlberg B., Eliasson M. The disparity in long-term survival after a first stroke in patients with and without diabetes persists: the Northern Sweden MONICA study. Cerebrovasc Dis. 2012; 34: 153–60.

7. Lei C., Wu B., Liu M., et al. Association between hemoglobin A1C levels and clinical outcome in ischemic stroke patients with or without diabetes. J Clin Neurosci. 2015; 22: 498–503.

8. Wu S., Wang C., Jia Q., et al. HbA1c is associated with increased all-cause mortality in the fi rst year after acute ischemic stroke. Neurol Res. 2014; 36: 444–52.

9. Piernik-Yoder B., Ketchum N. Rehabilitation outcomes of stroke patients with and without diabetes. Arch Phys Med Rehabil. 2013; 94: 1508–12.

10. 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.

11. 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.

12. 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.

13. Dedov I.I., Shestakova M.V., Mayorov A.Yu. (eds). Standards of specialized diabetes care. 9th ed. Moscow, 2019. DOI: https://doi.org/10.14341/DM221S1 (in Russian)

14. Inzucchi S.E., Khunti K., Fitchett D.H., et al. 19-LB: consistent cardiovascular (CV) benefits from empagliflozin across the spectrum of CV risk factor control: post hoc analysis from EMPA-REG OUTCOME. Diabetes. 2019; 68 (1).

15. American Diabetes Association Standards of Medical Care in Diabetes - 2018. Update. Diabetes Care. 2019; March.

16. Buehler A.M., Cavalcanti A.B., Berwanger O., et al. Effect of tight blood glucose control versus conventional control in patients with type 2 diabetes mellitus: a systematic review with meta-analysis of randomized controlled trials. Cardiovasc Ther. 2013; 31: 147-60.

17. Rathmann W., Kostev K., Gruenberger J.B., et al. Treatment persistence, hypoglycaemia and clinical outcomes in type 2 diabetes patients with dipeptidyl peptidase-4 inhibitors and sulphonylureas: a primary care database analysis. Diabetes Obes Metab. 2013; 15: 55-61.

18. Rosenstock J., Kahn S.E., Johansen O.E., et al. Effect of linagliptin vs glimepiride on major adverse cardiovascular outcomes in patients with type 2 diabetes. The CAROLINA Randomized Clinical Trial. JAMA. 2019; 322 (12): 1155-66.

19. Rosenstock J., Perkovic V., Johansen O.E., et al. Effect of linagliptin vs placebo on major cardiovascular events in adults with type 2 diabetes and high cardiovascular and renal risk: the CARMELINA randomized clinical trial. JAMA. 2019; 321 (1): 69-79. DOI: https://doi.org/10.1001/jama.2018.18269

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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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