Diabetes patients don’t often die from elevated serum glucose. They die from complications brought on by elevated serum glucose, most often cardiovascular and kidney complications.
Two back-to-back symposia on the first day of the Scientific Sessions will review the latest findings and new treatment strategies that can potentially mitigate life-threatening cardiac and kidney disease in diabetes. Mitigating ASCVD Risk in Diabetes—Update will begin at 2:00 p.m. CT on Friday, June 3, and The Role of Kidney in ASCVD will follow at 3:00 p.m. CT. Both sessions will be held in Great Hall B at the convention center and both sessions will be livestreamed for virtual meeting attendees.
“This is an interesting time in both diabetes and cardiology, as a lot of treatments we have considered as glucose-lowering medications are shifting over to being considered more as cardiovascular risk reduction,” said Suzanne V. Arnold, MD, MHA, Cardiologist and Professor of Medicine at the University of Missouri-Kansas City. “Cardiologists have been very hesitant to cross over into the endocrinology space and diabetologists have been more glucose-focused and don’t always think in terms of cardiovascular risk reduction. We both have a challenge to co-manage patients in a larger cardiometabolic space.”
Dr. Arnold will explore cardiometabolic risk reduction from the cardiology perspective during the first session. Sodium-glucose cotransporter-2 (SGLT2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists, both developed as glucose-lowering drugs, are two familiar classes of agents that blur the largely artificial boundaries between atherosclerotic cardiovascular disease and diabetes.
“It’s really about gaining a little more comfort with treatments that have been generally considered outside the realm of your usual practice,” Dr. Arnold said. “Our patients cross the boundaries between cardiology and diabetes, and we have to do the same to co-manage them more effectively.”
The same is true for patients with diabetic kidney disease, said Joshua J. Neumiller, PharmD, CDCES, FAADE, FASCP, the Allen I. White Distinguished Professor of Pharmacology and Pharmaceutical Sciences at Washington State University. SGLT2 inhibitor trials showed unexpected benefits in renal function whether patients had diabetes, kidney disease, or both. The same is true of GLP-1 receptor agonists and nonsteroidal mineralocorticoid receptor agonists.
“For the longest time, we didn’t have many options for kidney disease to slow progression and change the trajectory of peoples’ health and lives,” Dr. Neumiller said. “Now we have evidence of medications that can make a real difference in slowing progression of kidney disease in people who have diabetes. It’s not just about knowing where the current science stands, it’s about implementing use of these therapies in day-to-day practice.”
Implementing current science sometimes means changing ingrained habits. Implementing new blood pressure guidelines from KDIGO (Kidney Disease: Improving Global Outcomes) means more than lowering the systolic blood pressure target from 130 mmHg to 120 mmHg. It means standardizing the way blood pressure is measured.
“The latest KDIGO guideline blood pressure target is based heavily on the SPRINT trial from 2015, the year a landmark SGLT2 inhibitor trial was published,” said Alfred K. Cheung, MD, Chief of Nephrology & Hypertension at University of Utah Medicine. “ACCORD and meta-analyses of other trials were important contributors. Many guidelines emphasize that blood pressure must be measured following a procedure that includes proper—albeit simple—preparations of the patient that are often not followed in clinics.”
Blood pressure is one of the most widely used clinical measurements in medicine, Dr. Cheung continued. And unlike standardized tests for potassium, creatinine, or numerous other clinical measurements, blood pressure measurement is often not standardized and quality control is not well regulated.
“Using SGLT2 inhibitors in many patients with diabetes with proteinuria and cardiovascular risks is almost a no-brainer nowadays,” he said. “The proper assessment and management of blood pressure in people who have diabetes and/or chronic kidney disease the right way is probably just as important.”