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CVOTs: What did the endocrinologist learn?
Diabetes Research and Clinical Practice ( IF 5.1 ) Pub Date : 2019-11-26 , DOI: 10.1016/j.diabres.2019.107947
Paul Valensi 1 , Gaëtan Prévost 2
Affiliation  

The recent CVOTs which tested the new glucose-lowering drugs (GLD) show that in patients with type 2 diabetes mellitus (T2DM) it is now possible to reduce cardiovascular complications including ischemic events and hospitalization for heart failure, and mortality, and, to some extent, microvascular complications of diabetes, in particular renal outcomes. Additionally CVOTs provide major informations on safety and metabolic effects for long-term use of these drugs. The benefits with GLP-1 RAs are most likely derived through the reduction of atherosclerosis-related events while SGLT-2is seem mostly to reduce heart failure-related events. Specific mechanisms independent from glucose control are involved. Based on CVOTs results it is time, as stated in the new EASD-ADA and ESC/EASD guidelines, to take into consideration such opportunities in the decision-making process when treating T2DM patients, favoring the use of drugs that have shown clear cardiovascular and renal benefits. The treatment decisions require more expertise in the evaluation of cardiovascular and renal risk which becomes a major determinant for the choice of GLD treatment, the target for lipids, the adjustment of anti-hypertensive treatments and the prescription of aspirin. In this context it is essential that endocrinologists-diabetologists communicate more with cardiologists and nephrologists and with the primary care practitioners.

中文翻译:

CVOTs:内分泌专家学到了什么?

最近对新型降糖药(GLD)进行测试的CVOT表明,在2型糖尿病(T2DM)患者中,现在可以减少心血管并发症,包括缺血性事件以及因心力衰竭和死亡率而住院,甚至在某些情况下程度,糖尿病的微血管并发症,尤其是肾脏预后。此外,CVOT还提供了有关长期使用这些药物的安全性和代谢影响的主要信息。GLP-1 RA的益处很可能是通过减少与动脉粥样硬化相关的事件而获得的,而SGLT-2似乎主要是在减少与心力衰竭相关的事件。涉及独立于葡萄糖控制的特定机制。如新的EASD-ADA和ESC / EASD指南所述,基于CVOT的结果是时候了,在治疗T2DM患者时要在决策过程中考虑到此类机会,从而支持使用已显示出明显的心血管和肾脏益处的药物。治疗决策需要更多的心血管和肾脏风险评估专业知识,这成为选择GLD治疗,脂质靶点,调整抗高血压治疗方法和阿司匹林处方的主要决定因素。在这种情况下,内分泌学家-糖尿病学家必须与心脏病专家,肾脏病专家以及初级保健从业者进行更多的交流。治疗决策需要更多的心血管和肾脏风险评估专业知识,这成为选择GLD治疗,脂质靶点,调整抗高血压治疗方法和阿司匹林处方的主要决定因素。在这种情况下,内分泌学家-糖尿病学家必须与心脏病专家,肾脏病专家以及初级保健从业者进行更多的交流。治疗决策需要更多的心血管和肾脏风险评估专业知识,这成为选择GLD治疗,脂质靶点,调整抗高血压治疗方法和阿司匹林处方的主要决定因素。在这种情况下,内分泌学家-糖尿病学家必须与心脏病专家,肾脏病专家以及初级保健从业者进行更多的交流。
更新日期:2019-11-26
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