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Review
. 2021 Jan;9(1):46-52.
doi: 10.1016/S2213-8587(20)30343-0. Epub 2020 Nov 4.

Guideline recommendations and the positioning of newer drugs in type 2 diabetes care

Nikolaus Marx  1 , Melanie J Davies  2 , Peter J Grant  3 , Chantal Mathieu  4 , John R Petrie  5 , Francesco Cosentino  6 , John B Buse  7
Affiliations
Review

Guideline recommendations and the positioning of newer drugs in type 2 diabetes care

Nikolaus Marx et al. Lancet Diabetes Endocrinol. 2021 Jan.

Erratum in

Abstract

Cardiovascular outcome trials in patients with type 2 diabetes at high cardiovascular risk have led to remarkable advances in our understanding of the effectiveness of GLP-1 receptor agonists and SGLT2 inhibitors to reduce cardiorenal events. In 2019, the American Diabetes Association (ADA), European Association for the Study of Diabetes (EASD), and European Society of Cardiology (ESC) published updated recommendations for the management of such patients. We are concerned that ongoing discussions focusing on the differences between the endocrinologists' consensus report from the ADA and EASD and cardiologists' guidelines from the ESC are contributing to clinical inertia, thereby effectively denying evidence-based treatments advocated by both groups to patients with type 2 diabetes and cardiorenal disease. A subset of members from the writing groups of the ADA-EASD consensus report and the ESC guidelines was convened to emphasise where commonalities exist and to propose an integrated framework that encompasses the views incorporated in management approaches proposed by the ESC and the ADA and EASD. Coordinated action is required to ensure that people with type 2 diabetes, cardiovascular disease, heart failure, or chronic kidney disease are treated appropriately with an SGLT2 inhibitor or GLP-1 receptor agonist. In our opinion, this course should be initiated independent of background therapy, current glycaemic control, or individualised treatment goals.

Trial registration: ClinicalTrials.gov NCT04007926.

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Conflict of interest statement

NM, PJG, and FC were members of the writing group for the 2019 European Society of Cardiology guidelines. MJD, CM, and JBB were members of the writing group for the updated 2019 consensus report from the American Diabetes Association and European Association for the Study of Diabetes. NM has given lectures for Boehringer Ingelheim, Sanofi-Aventis, Merck Sharp & Dohme, Bristol-Myers Squibb, AstraZeneca, Lilly, and Novo Nordisk; has received unrestricted research grants from Boehringer Ingelheim; and has served as an advisor for Bayer, Boehringer Ingelheim, Sanofi-Aventis, Merck Sharp & Dohme, Bristol-Myers Squibb, AstraZeneca, and Novo Nordisk. NM has also served in trial leadership for Boehringer Ingelheim and Novo Nordisk. NM declines all personal compensation from pharmaceutical and device companies. MJD has served as a consultant, advisory board member, and speaker for Novo Nordisk, Sanofi-Aventis, Lilly, Merck Sharp & Dohme, Boehringer Ingelheim, AstraZeneca, and Janssen; an advisory board member for Servier and Gilead Sciences; and a speaker for the Napp Pharmaceuticals, Mitsubishi Tanabe Pharma Corporation, and Takeda Pharmaceuticals International. MJD has also received grants in support of investigator-initiated trials from Novo Nordisk, Sanofi-Aventis, Lilly, Boehringer Ingelheim, AstraZeneca, and Janssen. PJG is diabetes advisor to Synexus and editor-in-chief of Diabetes & Vascular Disease Research. PJG also reports delivering presentations and serving on the advisory board for Boehringer Ingelheim, Bayer, AstraZeneca, Lilly, Merck, Janssen Pharmaceutica, and Novo Nordisk. CM serves or has served on advisory panels for Novo Nordisk, Sanofi, Merck Sharp & Dohme, Eli Lilly, Novartis, AstraZeneca, Boehringer Ingelheim, Hanmi Pharmaceuticals, Roche, Medtronic, ActoBio Therapeutics, Pfizer, and UCB, with financial compensation for these activities received by KU Leuven. KU Leuven has also received research support for CM from Medtronic, Novo Nordisk, Sanofi, Merck Sharp & Dohme, Eli Lilly, Roche, Abbott, ActoBio Therapeutics, and Novartis. CM also serves or has served on speakers’ bureaux for Novo Nordisk, Sanofi, Merck Sharp & Dohme, Eli Lilly, Boehringer Ingelheim, AstraZeneca, and Novartis, with financial compensation for these activities received by KU Leuven. JRP reports personal fees via his employer (the University of Glasgow) for delivering presentations (for Merck KGaA, Novo Nordisk); serving on advisory boards (for Biocon, Novo Nordisk); and serving on ACI Clinical and IQVIA event adjudication committees for Boehringer Ingelheim. JRP has also received a research grant from Janssen to support an observational study and non-financial support (donation of study medication/ devices) from AstraZeneca, Dexcom, and Merck KGaA for investigator-initiated trials. FC reports delivering presentations and serving on the advisory board from Abbott, AstraZeneca, Bayer, Bristol-Myers Squibb, Merck Sharp & Dohme, Mundipharma, Novo Nordisk, and Pfizer. JBB’s contracted consulting fees and travel support for contracted activities are paid to the University of North Carolina by Adocia, AstraZeneca, Dance Biopharm, Dexcom, Eli Lilly, Fractyl, GI Dynamics, Intarcia Therapeutics, Lexicon, MannKind, Metavention, NovaTarg, Novo Nordisk, Orexigen, PhaseBio, Sanofi, Senseonics, vTv Therapeutics, and Zafgen. JBB also reports grant support from AstraZeneca, Eli Lilly, Intarcia Therapeutics, Johnson & Johnson, Lexicon, Medtronic, NovaTarg, Novo Nordisk, Sanofi, Theracos, Tolerion, and vTv Therapeutics; is a consultant to Cirius Therapeutics, CSL Behring, Fortress Biotech, Mellitus Health, Neurimmune, Pendulum Therapeutics, Stability Health, and Zealand Pharma; and holds stock or stock options in Mellitus Health, Pendulum Therapeutics, PhaseBio, and Stability Health.

Comment in

References

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