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Content Update

May 10, 2019

Beneficial Cardiorenal Effects of SGLT2 Inhibitors: Type 2 diabetes (T2D) is a significant risk factor for additional health problems, such as chronic kidney disease (CKD) and cardiovascular events. Current guidelines suggest use of an SGLT2 inhibitor or GLP-1 agonist for T2D patients with established atherosclerotic cardiovascular disease (ASCVD) or CKD but do not address cardiorenal outcomes in patients without ASCVD or CKD. Three recent clinical trials provide evidence of cardiorenal benefits of SGLT2 inhibitors in patients with T2D. The two drugs evaluated, canagliflozin and dapagliflozin, prevented and reduced hospitalizations due to heart failure and progressive kidney disease. The studies included patients with and without prior cardiovascular events, as well as varying levels of kidney function, and found no heterogeneity. Together with the known beneficial effects of empagliflozin, this new information indicates that cardiorenal benefits are a class effect of SGLT2 inhibitors.

LEARNING OBJECTIVES

LEARNING OBJECTIVES

Upon completion of the chapter, the reader will be able to:

  1. Discuss the incidence of diabetes mellitus (DM).

  2. Distinguish clinical differences in type 1, Latent Autoimmune Diabetes of Adulthood, type 2, and gestational diabetes.

  3. List screening and diagnostic criteria for DM.

  4. Discuss therapeutic goals for blood glucose (BG) and blood pressure (BP) for a patient with diabetes.

  5. Recommend nonpharmacologic therapies, including meal planning and physical activity, for patients with diabetes.

  6. Compare oral agents used in treating diabetes by their mechanisms of action, time of action, side effects, contraindications, and effectiveness.

  7. Select appropriate insulin therapy based on onset, peak, and duration of action.

  8. Discuss the signs, symptoms, and treatment of hypoglycemia.

  9. Define diabetic ketoacidosis and discuss treatment goals.

  10. Develop a comprehensive therapeutic monitoring plan for a patient with diabetes based on patient-specific factors.

INTRODUCTION

Diabetes mellitus (DM) describes a group of chronic metabolic disorders. Image not available. DM is characterized by hyperglycemia that may result in long-term microvascular and neuropathic complications. These complications contribute to DM being the leading cause of (a) new cases of blindness among adults, (b) end-stage renal disease, and (c) nontraumatic lower limb amputations. Macrovascular complications (coronary artery disease, peripheral vascular disease, and stroke) are also associated with DM.

EPIDEMIOLOGY

DM affects an estimated 30.3 million persons in the United States, or 9.4% of the population.1 Although an estimated 23.1 million persons have been diagnosed, another 7.2 million have DM but are unaware they have the disease.

DM is characterized by a complete lack of insulin, a relative lack of insulin, or insulin resistance as well as disorders of other hormones. These defects result in an inability to use glucose for energy. The increasing prevalence of DM is partly caused by three influences: lifestyle, ethnicity, and age.

Lifestyle

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