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).
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