Intensifying Diabetes Therapies to Achieve Personalized Treatment Goals-Overview of Key Updates

Video Transcription

Video Summary

This video presentation discusses the updated guidelines in the management of patients with type 2 diabetes and highlights the importance of individualized treatment and a complication-centric approach. Specifically, the focus is on patients with chronic kidney disease, atherosclerotic heart disease, and heart failure. Diabetic kidney disease is identified as a leading cause of kidney failure worldwide and is a major contributor to morbidity and mortality in type 2 diabetes. Screening for kidney disease in patients with type 2 diabetes is recommended using glomerular filtration rate (GFR) and albuminuria criteria.<br /><br />Chronic kidney disease is recognized as a cardiovascular risk equivalent and is a major risk factor for cardiovascular disease. The video highlights the impact of kidney disease on lifespan, with a combination of diabetes and kidney disease shortening lifespan by 16 years. The KidneyGo workgroup has developed a heat map using GFR decline and proteinuria to stratify patient risk. Sodium-glucose co-transporter inhibitors (SGL-2 inhibitors) and glucagon-like peptide 1-receptor agonists (GLP-1 receptor agonists) are recommended for patients with heart failure, atherosclerotic heart disease, and chronic kidney disease, independent of glycemic control.<br /><br />The mechanisms of action and biological effects of SGL-2 inhibitors and GLP-1 receptor agonists are discussed, including their impact on renal hemodynamics, weight loss, and glucose control. Several trials and meta-analyses support the cardio-renal protective effects of these medications. Adverse events associated with these medications, such as euglycemic ketoacidosis and genital mycotic infections, are also addressed.<br /><br />The video concludes with the revised complication-centric algorithm for managing patients with chronic kidney disease, heart failure, and atherosclerotic heart disease, emphasizing the use of SGL-2 inhibitors and GLP-1 receptor agonists for their organ protective effects. Glycemic control is secondary to these benefits in this patient population. The choice of medication depends on the individual patient's condition and tolerability.

Keywords

type 2 diabetes

individualized treatment

chronic kidney disease

heart failure

SGL-2 inhibitors

GLP-1 receptor agonists

cardio-renal protective effects

glycemic control