DCRM Multispecialty Practice Recommendations for the management of diabetes, cardiorenal, and metabolic diseases

Yehuda Handelsman¹, John E Anderson², George L Bakris³, Christie M Ballantyne⁴, Joshua A Beckman⁵, Deepak L Bhatt⁶, Zachary T Bloomgarden⁷, Biykem Bozkurt⁴, Matthew J Budoff⁸, Javed Butler⁹, Samuel Dagogo-Jack¹⁰, Ian H de Boer¹¹, Ralph A DeFronzo¹², Robert H Eckel¹³, Daniel Einhorn¹⁴, Vivian A Fonseca¹⁵, Jennifer B Green¹⁶, George Grunberger¹⁷, Chris Guerin¹⁸, Silvio E Inzucchi¹⁹, Paul S Jellinger²⁰, Mikhail N Kosiborod²¹, Pamela Kushner²², Norman Lepor⁸, Christian W Mende¹⁸, Erin D Michos²³, Jorge Plutzky⁶, Pam R Taub¹⁸, Guillermo E Umpierrez²⁴, Muthiah Vaduganathan⁶, Matthew R Weir²⁵

Affiliations

¹ Metabolic Institute of America, Tarzana, CA, USA. Electronic address: yhandelsman@gmail.com.
² The Frist Clinic, Nashville, TN, USA.
³ University of Chicago Medicine, Chicago, IL, USA.
⁴ Baylor College of Medicine, Houston, TX, USA.
⁵ Vanderbilt University Medical Center, Nashville, TN, USA.
⁶ Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
⁷ Mount Sinai School of Medicine, New York, NY, USA.
⁸ David Geffen School of Medicine, UCLA, Los Angeles, CA, USA.
⁹ University of Mississippi Medical Center, Jackson, MS, USA.
¹⁰ University of Tennessee Health Science Center, Memphis, TN, USA.
¹¹ University of Washington, Seattle, WA, USA.
¹² University of Texas Health Science Center, San Antonio, TX, USA.
¹³ University of Colorado Anschutz Medical Campus, Denver, CO, USA.
¹⁴ Scripps Whittier Institute for Diabetes, San Diego, CA, USA.
¹⁵ Tulane University Health Sciences Center, New Orleans, LA, USA.
¹⁶ Duke University Medical Center, Durham, NC, USA.
¹⁷ Grunberger Diabetes Institute, Bloomfield Hills, MI, USA, Wayne State University School of Medicine, Detroit, MI, USA, Oakland University William Beaumont School of Medicine, Rochester, MI, USA, Charles University, Prague, Czech Republic.
¹⁸ University of California San Diego School of Medicine, San Diego, CA, USA.
¹⁹ Yale School of Medicine, New Haven, CT, USA.
²⁰ The Center for Diabetes & Endocrine Care, University of Miami Miller School of Medicine, Hollywood, FL, USA.
²¹ Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, MO, USA.
²² University of California at Irvine, Irvine, CA, USA.
²³ Johns Hopkins University School of Medicine, Baltimore, MD, USA.
²⁴ Emory University, Atlanta, GA, USA.
²⁵ University of Maryland School of Medicine, Baltimore, MD, USA.

PMID: 34922811
PMCID: PMC9803322
DOI: 10.1016/j.jdiacomp.2021.108101

Review

DCRM Multispecialty Practice Recommendations for the management of diabetes, cardiorenal, and metabolic diseases

Yehuda Handelsman et al. J Diabetes Complications. 2022 Feb.

. 2022 Feb;36(2):108101.

doi: 10.1016/j.jdiacomp.2021.108101. Epub 2021 Dec 7.

Authors

Affiliations

¹ Metabolic Institute of America, Tarzana, CA, USA. Electronic address: yhandelsman@gmail.com.
² The Frist Clinic, Nashville, TN, USA.
³ University of Chicago Medicine, Chicago, IL, USA.
⁴ Baylor College of Medicine, Houston, TX, USA.
⁵ Vanderbilt University Medical Center, Nashville, TN, USA.
⁶ Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
⁷ Mount Sinai School of Medicine, New York, NY, USA.
⁸ David Geffen School of Medicine, UCLA, Los Angeles, CA, USA.
⁹ University of Mississippi Medical Center, Jackson, MS, USA.
¹⁰ University of Tennessee Health Science Center, Memphis, TN, USA.
¹¹ University of Washington, Seattle, WA, USA.
¹² University of Texas Health Science Center, San Antonio, TX, USA.
¹³ University of Colorado Anschutz Medical Campus, Denver, CO, USA.
¹⁴ Scripps Whittier Institute for Diabetes, San Diego, CA, USA.
¹⁵ Tulane University Health Sciences Center, New Orleans, LA, USA.
¹⁶ Duke University Medical Center, Durham, NC, USA.
¹⁷ Grunberger Diabetes Institute, Bloomfield Hills, MI, USA, Wayne State University School of Medicine, Detroit, MI, USA, Oakland University William Beaumont School of Medicine, Rochester, MI, USA, Charles University, Prague, Czech Republic.
¹⁸ University of California San Diego School of Medicine, San Diego, CA, USA.
¹⁹ Yale School of Medicine, New Haven, CT, USA.
²⁰ The Center for Diabetes & Endocrine Care, University of Miami Miller School of Medicine, Hollywood, FL, USA.
²¹ Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, MO, USA.
²² University of California at Irvine, Irvine, CA, USA.
²³ Johns Hopkins University School of Medicine, Baltimore, MD, USA.
²⁴ Emory University, Atlanta, GA, USA.
²⁵ University of Maryland School of Medicine, Baltimore, MD, USA.

PMID: 34922811
PMCID: PMC9803322
DOI: 10.1016/j.jdiacomp.2021.108101

Abstract

Type 2 diabetes (T2D), chronic kidney disease (CKD), atherosclerotic cardiovascular disease (ASCVD), and heart failure (HF)-along with their associated risk factors-have overlapping etiologies, and two or more of these conditions frequently occur in the same patient. Many recent cardiovascular outcome trials (CVOTs) have demonstrated the benefits of agents originally developed to control T2D, ASCVD, or CKD risk factors, and these agents have transcended their primary indications to confer benefits across a range of conditions. This evolution in CVOT evidence calls for practice recommendations that are not constrained by a single discipline to help clinicians manage patients with complex conditions involving diabetes, cardiorenal, and/or metabolic (DCRM) diseases. The ultimate goal for these recommendations is to be comprehensive yet succinct and easy to follow by the nonexpert-whether a specialist or a primary care clinician. To meet this need, we formed a volunteer task force comprising leading cardiologists, nephrologists, endocrinologists, and primary care physicians to develop the DCRM Practice Recommendations, a multispecialty consensus on the comprehensive management of the patient with complicated metabolic disease. The task force recommendations are based on strong evidence and incorporate practical guidance that is clinically relevant and simple to implement, with the aim of improving outcomes in patients with DCRM. The recommendations are presented as 18 separate graphics covering lifestyle therapy, patient self-management education, technology for DCRM management, prediabetes, cognitive dysfunction, vaccinations, clinical tests, lipids, hypertension, anticoagulation and antiplatelet therapy, antihyperglycemic therapy, hypoglycemia, nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH), ASCVD, HF, CKD, and comorbid HF and CKD, as well as a graphical summary of medications used for DCRM.

Keywords: Atherosclerotic cardiovascular disease; Chronic kidney disease; Clinical practice; Consensus recommendations; Heart failure; Type 2 diabetes.

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Conflict of interest statement

Declaration of competing interest

None of the Task Force members received monetary renumeration for their contributions to the creation or writing of this consensus document. See the Supplementary Appendix for full declarations of competing interests for each author.

References

1. Centers for Disease Control and Prevention. Chronic kidney disease surveillance system—United States; https://nccd.cdc.gov/CKD/. Accessed 19 November 2019.
1. Centers for Disease Control and Prevention. National diabetes statistics report, 2017. Atlanta, GA: Centers for Disease Control and Prevention, U.S. Dept of Health and Human Services; 2017.
1. Plantinga LC, Crews DC, Coresh J, et al. Prevalence of chronic kidney disease in US adults with undiagnosed diabetes or prediabetes. Clin J Am Soc Nephrol. 2010;5: 673–682. - PMC - PubMed
1. Kidney Disease: Improving Global Outcomes CKD Work Group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl. 2013;3:1–150. - PubMed
1. Garber AJ, Handelsman Y, Grunberger G, et al. Consensus statement by the american Association of Clinical Endocrinologists and American College of endocrinology on the comprehensive type 2 diabetes management algorithm—2020 executive summary. Endocr Pract. 2020;26:107–139. - PubMed

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DCRM Multispecialty Practice Recommendations for the management of diabetes, cardiorenal, and metabolic diseases

Affiliations

DCRM Multispecialty Practice Recommendations for the management of diabetes, cardiorenal, and metabolic diseases

Authors

Affiliations

Abstract

Conflict of interest statement

References

Publication types

MeSH terms

Substances

Grants and funding

LinkOut - more resources

Full Text Sources

Medical

Research Materials

Miscellaneous