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Review
. 2022 Dec;16(12):102661.
doi: 10.1016/j.dsx.2022.102661. Epub 2022 Nov 2.

Cardiorenal disease management in type 2 diabetes: An expert consensus

Viswanathan Mohan  1 , Awadhesh Kumar Singh  2 , Abdul Hamid Zargar  3 , Alan Almeida  4 , Anil Kumar Bhalla  5 , Jagadish Chander Mohan  6 , Jamshed Dalal  7 , Manisha Sahay  8 , Padhinhare P Mohanan  9 , Sanjay Maitra  10 , Sujoy Ghosh  11 , Tarun Jeloka  12 , Upendra Kaul  13 , Vinay Sakhuja  14 , Mrinal Kanti Das  15
Affiliations
Review

Cardiorenal disease management in type 2 diabetes: An expert consensus

Viswanathan Mohan et al. Diabetes Metab Syndr. 2022 Dec.

Abstract

Background and aim: The interplay between cardiovascular disease (CVD), chronic kidney disease (CKD) and type 2 diabetes (T2D) is well established. We aim at providing an evidence-based expert opinion regarding the prevention and treatment of both heart failure (HF) and renal complications in people with T2D.

Method: ology: The consensus recommendations were developed by subject experts in endocrinology, cardiology, and nephrology. The criteria for consensus were set to statements with ≥80% of agreement among clinicians specialized in endocrinology, cardiology, and nephrology. Key expert opinions were formulated based on scientific evidence and clinical judgment.

Results: Assessing the risk factors of CVD or CKD in people with diabetes and taking measures to prevent HF or kidney disease are essential. Known CVD or CKD among people with diabetes confers a very high risk for recurrent CVD. Metformin plus lifestyle modification should be the first-line therapy (unless contraindicated) for the management of T2D. Glucagon-like peptide 1 (GLP-1) agonists can be preferred in people with atherosclerotic cardiovascular disease (ASCVD) or with high-risk indicators, along with sodium-glucose cotransporter-2 inhibitors (SGLT2i), whereas SGLT2i are the first choice in HF and CKD. The GLP-1 agonists can be used in people with CKD if SGLT2i are not tolerated.

Conclusion: Current evidence suggests SGLT2i as preferred agents among people with T2D and HF, and for those with T2D and ASCVD. SGLT2i and GLP-1RA also lower CV outcomes in those with diabetes and ASCVD, and the treatment choice should depend on the patient profile.

Keywords: CV risk Assessment; Dapagliflozin; GLP-1 agonists; Indian phenotype; SGLT2i.

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Conflict of interest statement

Declaration of competing interest Dr. V. Mohan has served as a consultant and speaker and received research or educational grants from Astra Zeneca, Novo Nordisk, MSD, Novartis, Boehringer Ingelheim, USV, Dr. Reddy's Laboratories, Eli Lilly, Lifescan J & J, Sanofi-Aventis, Roche Diagnostics, Abbott, and several Indian pharmaceutical companies.Dr. A.K. Singh has no conflicts of interest to declare. Dr. A.H. Zargar was a speaker/advisor for Boehringer Ingelheim, AstraZeneca, and Johnson and Johnson and has received honoraria for his professional services. Dr. Alan Almeida has served as a consultant and speaker for Abbott, AstraZeneca, Bayer, and Dr. Reddy's Laboratories and has received honoraria for the same. Dr. A.K. Bhalla has been a speaker/advisor for Dr. Reddy ’s, Zydus, La Renon Healthcare, Fresenius Kabi, Boehringer Ingelheim, AstraZeneca, Novartis, Pfizer, Abbott, Bayer, Boston Scientific, GE, and Siemens and has received honoraria for his professional services from them. He has been part of trials sponsored by Zydus, Baxter, Siemens, GE, Abbott, AstraZeneca, and PPD as a principal investigator (PI).Dr. J.C. Mohan has been a speaker/advisor for Johnson and Johnson, Boehringer Ingelheim, AstraZeneca, Novartis, Pfizer, Abbott, Bayer, Boston Scientific, GE, Siemens, Toshiba Health Systems and has received honoraria for his professional services from them. He has been part of the ATTR-ACT trial of Pfizer as a PI.Dr. Jamshed Dalal has received speaker honoraria from Astra Zeneca Pharma India Limited and Boehringer Ingelheim, India. Dr. Manisha Sahay has received speaker honoraria from AstraZeneca and Johnson and Johnson. Dr. P.P. Mohanan has received an honorarium from AstraZeneca for academic purposes. Dr. Sanjay Maitra has been a speaker/advisor for Johnson and Johnson, Boehringer Ingelheim, and AstraZeneca, Dr. Sujoy Ghosh has served as a consultant and speaker and received research or educational grants from Astra Zeneca, Novo Nordisk, MSD, Novartis, Boehringer Ingelheim, Glenmark, USV, Dr. Reddy's Laboratories, Eli Lilly, Lifescan J & J, Sanofi-Aventis, Roche Diagnostics, Abbott, and several Indian pharmaceutical companies. Dr. Tarun Jeloka has been a speaker/advisor for AstraZeneca and Zydus and has received honoraria for his professional services from them. Dr. Upendra Kaul has been a speaker/advisor for Boehringer Ingelheim, AstraZeneca, Novartis, Pfizer, Abbott, Bayer, Medtronic, Boston Scientific, and GE and has received honoraria for his professional services from them. He has been associated with PARAGON-HF, EMPEROR-Reduced, and EMPEROR-Preserved trials as a PI. Dr. Vinay Sakhuja has no conflicts of interest to declare. Dr. M.K. Das has no conflicts of interest to declare.

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