Newer Type 2 diabetes medications have heart and kidney dise
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Two newer groups of medications prescribed primarily for Type 2 diabetes treatment (SGLT2 inhibitors and GLP-1 receptor agonists) could significantly reduce risks associated with chronic kidney disease (CKD) and heart disease. Based on analyses of the clinical trials through March 2020, a group of leading experts in diabetes, heart failure, kidney disease and cardiometabolic disease believe the medicines should be considered for people with CKD and Type 2 diabetes to protect against heart and kidney disease and their serious complications, according to a new Scientific Statement from the AHA.

The statement reviews evidence from multiple, large, international, randomized controlled trials of two classes of blood sugar control medications -- sodium glucose co-transporter 2 (SGLT2) inhibitors and glucagon like peptide-1 receptor agonists (GLP-1 RAs) -- in patients with Type 2 diabetes, chronic kidney disease and those who were either at risk for or already had cardiovascular disease.

The composite results of the trials found that SGLT2 inhibitors and GLP-1 RAs can safely and significantly reduce the risk of cardiovascular events and death, reduce hospitalization and slow the progression of chronic to end-stage kidney disease including the risks of dialysis, transplantation or death.

Analysis of the clinical trials results yielded these recommendations:

-- Early and ongoing assessment of risks for kidney and heart disease can help identify patients who may benefit from the protective and preventive effects of these medicines.
-- Tailor medication choices to meet the needs of each individual patient.
-- Monitoring and control of high blood pressure.
-- Identify risks for hypoglycemia (low-blood sugar) and educate patients on the signs so they can seek treatment quickly.
-- Adjust all medications in tandem with these medicines and consider the burden of “polypharmacy” – meaning taking 5 or more medications daily for multiple conditions, which is common among people with Type 2 diabetes.
-- Patients should be counseled about the risks and symptoms of “euglycemic” diabetic ketoacidosis (DKA), when taking SGLT2 inhibitors as well as “classic” DKA (when blood sugar is very high and acidic substances called ketones build up in the body), which is serious and can be fatal.
-- The health care professional team should regularly screen and counsel patients about regular foot care to prevent foot ulcers or blisters that can quickly become infected and lead to amputation.

The writing group identified two additional patient subgroups who may benefit from SGLT2 inhibitors and GLP-1 RAs: people with heart failure with reduced ejection fraction (HFrEF) with or without Type 2 diabetes; and people with chronic kidney disease who do not have Type 2 diabetes. The writing group anticipates more data emerging to validate the use of SGLT2 inhibitors and GLP-1 RA medications for these at-risk patients.

Source: https://newsroom.heart.org/news/newer-type-2-diabetes-medications-have-heart-and-kidney-disease-benefits-too?preview=bb34
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