Dr KK Aggarwal
President CMAAO and HCFI
In 2020, the American Diabetes Association is making two paradigm-shifting recommendations in the treatment of type 2 diabetes.
1. Prescribe Sodium glucose co-transporter 2 (SGLT2) inhibitors or glucagon-like peptide 1 (GLP-1) receptor agonists to patients at high risk for atherosclerotic cardiovascular disease, heart failure, or chronic kidney disease, in addition to patients with already established disease, as previously recommended.
2. Consideration for use of those drugs be independent of the patient's baseline A1c or individualized A1c target. Previously, additional pharmacologic agents were recommended only when A1c was above target despite using first-line metformin and lifestyle interventions.
Atherosclerotic CV Disease: Add Empagliflozin
Heart Failure: Empagliflozin, canagliflozin or dapagliflozin. For patients with heart failure with reduced ejection fraction (HFrEF) who have persistent symptoms and an elevated serum natriuretic peptide level on optimal pharmacologic and device therapy, add dapagliflozin.
CKD: Canagliflozin in patients with diabetes and proteinuria: In patients with type 2 diabetes who have nephropathy (urine albumin excretion >300 mg per day) and eGFR >30 mL/min per 1.73 m2, add Canagliflozin (CREDENCE trial).