A panel of experts will discuss the latest recommendations and research findings regarding treatment options for patients with common diabetes comorbidities during the Virtual 80th Scientific Sessions symposium Tailoring Treatment Options Based on Diabetes Comorbidities at 4:15 p.m. CT Friday, June 12.
During the two-hour virtual presentation, George Bakris, MD, will discuss the treatment of patients with low estimated glomerular filtration rate (eGFR). Dr. Bakris is Professor of Medicine and Director of the Comprehensive Hypertension Center at University of Chicago Medicine.
“Patients with diabetes who have a low GFR, defined as <60ml/min/1.73m2, represent a group with diabetic kidney disease, the most common cause of kidney failure in the world,” Dr. Bakris said. “While there are clear data on what to do in advanced stages of kidney disease with levels 30% to 40% lower than this, there is much the primary care doctor or endocrinologist can do to preserve kidney function, but it is not happening.”
All available data, he said, is in the range of GFR 30 to 59 ml/min. There are no trials in people with a GFR of 15 to 29 ml/min that assess outcomes, primarily due to safety concerns, hyperkalemia, and a large drop in GFR with recommended therapies, angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs).
While hyperkalemia was once a major hinderance to not using renin-angiotensin system (RAS) blockers, Dr. Bakris noted that—with the new potassium binders Lokelma (ZS-9) and Veltassa (patiromer) now available—RAS blockers can be used without fear of hyperkalemia.
“Importantly, you should not stop an ACE inhibitor or ARB if serum creatinine goes up as high as 30% without hyperkalemia, as those people will have a good outcome and fewer CV [cardiovascular] events,” Dr. Bakris said. “Additionally, you need to control both glucose and blood pressure to guideline goals—and don’t forget an SGLT2 (sodium-glucose transporter 2) inhibitor as part of that mix.”
In another presentation, Silvio E. Inzucchi, MD, Professor of Medicine (Endocrinology) at Yale School of Medicine and Medical Director of the Yale Diabetes Center, will discuss treatment options for patients with heart failure.
“Heart failure is an increasingly recognized complication of diabetes and, once established, portends a poor prognosis,” Dr. Inzucchi said. “Unfortunately, glucose control by itself does not appear to mitigate the risk of heart failure. Moreover, some glucose-lowering drugs have actually, and paradoxically, been associated with worse heart failure outcomes.”
SGLT2 inhibitors, on the other hand, are now widely recognized as glucose-lowering agents that reduce heart failure hospitalizations, he said, and are emerging as a standard therapy for type 2 diabetes patients with heart failure.
“The benefits of the SGLT2 inhibitors apply to patients both with and without baseline heart failure and therefore may be considered not only for the treatment of patients with diabetes and heart failure, but also as a preventive strategy, especially in those with underlying atherosclerotic cardiovascular dise ce of diabetes.”
Also during the symposium, Jesse Dawson, MD, BSc (Hons), FRCP, FESO, will discuss the treatment of patients with diabetes after stroke/transient ischemic attack (TIA). Dr. Dawson is Professor of Stroke Medicine at the University of Glasgow College of Medical, Veterinary and Life Sciences, and Consultant Physician at Queen Elizabeth University Hospital.
“People with stroke and TIA have a high risk of recurrent events, and stroke survivors with diabetes have worse outcomes compared to people with no diabetes,” Dr. Dawson said. “There are a number of new treatments for type 2 diabetes, and clarity around how these effect risk of stroke and second stroke is only just emerging.”
Dr. Dawson will discuss the risk of stroke and recurrent stroke in people with diabetes and examine which new drugs have the biggest impact on stroke, including whether or not pioglitazone should be used in people with insulin resistance and stroke.
“Pioglitazone is a very promising therapy to reduce recurrent events and we should work on strategies to make it safer,” he said.
The symposium’s other presenter, Kenneth Cusi, MD, FACP, FACE, Professor of Medicine and Chief of the Division of Endocrinology, Diabetes and Metabolism in the Department of Medicine at the University of Florida, will discuss the treatment of diabetes patients who have nonalcoholic fatty liver disease/nonalcoholic steatohepatitis.