Consensus Recommendations for Management Of Patients with Ty
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The recent American Diabetes Association and the European Association for the Study of Diabetes guideline mentioned glycaemia management in type 2 diabetes mellitus (T2DM) patients with cardiovascular diseases (CVDs), however, it did not cover the treatment approaches for patients with T2DM having a high risk of CVD, and treatment and screening approaches for CVDs in patients with concomitant T2DM. This consensus guideline undertakes the data obtained from all the cardiovascular outcome trials (CVOTs) to propose approaches for the T2DM management in presence of CV comorbidities.

A multidisciplinary expert panel of specialised endocrinologists and cardiologists, with clinical and research expertise in the diagnosis and treatment of T2DM and CVD, was convened and recommendations were formulated. All the available evidences were comprehensively reviewed, discussed, developed, and final decisions were made by the panel.

1. Researchers recommend starting GLP1-receptor agonists (GLP1-RA) or SGLT2 inhibitors (SGLT2i) as a second/third line therapy in patients with T2DM and who are at high risk for CVD or renal impairment.
2. Researchers recommend using pioglitazone (thiazolidinedione) as a fourth line therapy in patients with T2DM and high risk for CVD.
3. If high-risk patients did not achieve patient specific HbA1c target, we recommend using either DPP4 inhibitors (DPP4i), sulphonylureas, glinides, acarbose (α-glucosidase inhibitor), or insulin.
4. Researchers recommend using GLP1-RA along with life style changes and metformin as a first line therapy.
we recommend using SGLT2i as second line therapy in patients with ASCVD.
5. Researchers recommend using one of the following options if the glycaemic targets are yet not met: DPP4i, sulphonylureas, acarbose (α-glucosidase inhibitor), glinides, or insulin.

Diabetes is currently considered a cardiovascular disease, given the fact that all complications are vascular (micro and macrovascular complications). Hence, management of diabetes and especially those with a history of CVD in a joint clinic by cardiologist and an endocrinologist would seem a logical approach. The authors, therefore, recommend a new T2DM/CVD clinic or a cardiometabolic clinic that follows a novel algorithm for the management of T2DM in patients with CVDs. The facilities provided at the clinic would be for T2DM patients with a history of HF or ischaemic heart disease.

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