RESUMO
BACKGROUND AND AIM: The interplay between cardiovascular disease (CVD), chronic kidney disease (CKD) and type 2 diabetes (T2D) is well established. We aim at providing an evidence-based expert opinion regarding the prevention and treatment of both heart failure (HF) and renal complications in people with T2D. METHOD: ology: The consensus recommendations were developed by subject experts in endocrinology, cardiology, and nephrology. The criteria for consensus were set to statements with ≥80% of agreement among clinicians specialized in endocrinology, cardiology, and nephrology. Key expert opinions were formulated based on scientific evidence and clinical judgment. RESULTS: Assessing the risk factors of CVD or CKD in people with diabetes and taking measures to prevent HF or kidney disease are essential. Known CVD or CKD among people with diabetes confers a very high risk for recurrent CVD. Metformin plus lifestyle modification should be the first-line therapy (unless contraindicated) for the management of T2D. Glucagon-like peptide 1 (GLP-1) agonists can be preferred in people with atherosclerotic cardiovascular disease (ASCVD) or with high-risk indicators, along with sodium-glucose cotransporter-2 inhibitors (SGLT2i), whereas SGLT2i are the first choice in HF and CKD. The GLP-1 agonists can be used in people with CKD if SGLT2i are not tolerated. CONCLUSION: Current evidence suggests SGLT2i as preferred agents among people with T2D and HF, and for those with T2D and ASCVD. SGLT2i and GLP-1RA also lower CV outcomes in those with diabetes and ASCVD, and the treatment choice should depend on the patient profile.
Assuntos
Aterosclerose , Doenças Cardiovasculares , Diabetes Mellitus Tipo 2 , Insuficiência Cardíaca , Hipertensão Renal , Insuficiência Renal Crônica , Inibidores do Transportador 2 de Sódio-Glicose , Humanos , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/terapia , Diabetes Mellitus Tipo 2/induzido quimicamente , Hipoglicemiantes/uso terapêutico , Doenças Cardiovasculares/prevenção & controle , Doenças Cardiovasculares/complicações , Inibidores do Transportador 2 de Sódio-Glicose/farmacologia , Consenso , Insuficiência Cardíaca/tratamento farmacológico , Aterosclerose/tratamento farmacológico , Hipertensão Renal/induzido quimicamente , Hipertensão Renal/complicações , Hipertensão Renal/tratamento farmacológico , Peptídeo 1 Semelhante ao Glucagon , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/terapia , Gerenciamento Clínico , Receptor do Peptídeo Semelhante ao Glucagon 1RESUMO
The Asian-Indian phenotype of type 2 diabetes mellitus is uniquely characterized for cardio-metabolic risk. In the context of implementing patient-centric holistic cardio-metabolic risk management as a priority, the choice of various combinations of antidiabetic agents should be individualized. Combined therapy with two classes of antidiabetic agents, namely, dipeptidyl peptidase 4 inhibitors and sodium-glucose co-transporter-2 inhibitors, target several pathophysiological pathways. The wide-ranging clinical outcomes associated with this combination, including improvement of glycemia and adiposity, reduction of metabolic and vascular risk, safety, and simplicity for sustainable compliance, are extremely relevant to the Asian Indian patient population living with T2DM. In this review we describe the available evidence in detail and present a rational practical guidance for the optimum clinical use of this combination in this patient population.
RESUMO
BACKGROUND: India is the largest hub for bariatric and metabolic surgery in Asia. OSSI is committed to improve the quality of care and set the standards for its practice in India. METHODS: The first draft of OSSI guidelines was prepared by the secretary, Dr. Praveen Raj under the guidance of current President, Dr. Arun Prasad. All executive council members were given voting privileges, and the proposed guidelines were circulated on email for approval of the executive council. Guidelines were finalized after 100% agreement from all voting members and were also circulated among all OSSI members for their suggestions. RESULTS: OSSI upholds the BMI criteria for bariatric and metabolic surgery of 2011 IFSO-APC guidelines. In addition to this, we recognize that waist circumference of ≥ 80 cm in females and ≥ 90 cm in males along with obesity related co-morbidities may be considered for surgery. In addition to standard procedures as recommended by IFSO, OSSI acknowledges the additional procedures, and a review of literature for these procedures is presented in the discussion. CONCLUSION: The burden of obesity in India is one of the highest in the world and with numbers of bariatric and metabolic procedures rising rapidly; there is a need for country specific guidelines. The Indian population is unique in its phenotype, genotype and nutritional make up. This document enlists guidelines for surgeons and allied health practitioners as also multiple other stake-holders like primary health physicians, policy makers, insurance companies and the Indian government.