Advertisement

Current Diabetes Reports

, 19:157 | Cite as

Bridging the Gap for Patients with Diabetes and Cardiovascular Disease Through Cardiometabolic Collaboration

  • Lee-Shing ChangEmail author
  • Muthiah Vaduganathan
  • Jorge Plutzky
  • Vanita R. Aroda
Health Care Delivery Systems and Implementation in Diabetes (ME McDonnell and AR Sadhu, Section Editors)
  • 1 Downloads
Part of the following topical collections:
  1. Topical Collection on Health Care Delivery Systems and Implementation in Diabetes

Abstract

Purpose of Review

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in individuals with type 2 diabetes (T2D). Recent cardiovascular outcome trials (CVOTs) have established sodium-glucose co-transporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP1 RA) as powerful medications that can lower glucose as well as reduce the risk of complications of CVD in many individuals with T2D. The combination of glycemic and cardiovascular benefits of SGLT2i and GLP1 RA has highlighted the importance of collaborative care of patients by diabetes and cardiovascular specialists. We review several models of cardiometabolic care for patients with diabetes and CVD and discuss practical ways in which diabetes and cardiovascular specialists can work together to improve cardiometabolic care.

Recent Findings

CVOTs for SGLT2i and GLP1 RA have demonstrated a significant reduction in major adverse cardiovascular events in individuals with T2D and CVD, in addition to their beneficial effects on glucose lowering and weight loss. Additionally, several models of care, including population health screening models with or without a remote management intervention, multidisciplinary clinics, and combined cardiometabolic training, have been proposed to better facilitate the multifaceted care that individuals with diabetes and CVD require.

Summary

Innovative models of cardiometabolic care have the potential to improve the quality of care that individuals with diabetes and CVD receive. Through collaboration and co-management, diabetes specialists, cardiovascular specialists, and primary care providers have the ability to optimize diabetes and cardiovascular care.

Keywords

Type 2 diabetes Cardiometabolic SGLT2 inhibitors GLP1 receptor agonists Cardiovascular outcome trials 

Notes

Compliance with Ethical Standards

Conflict of Interest

Lee-Shing Chang reports grants from Boehringer Ingelheim, Sanofi, and Novo Nordisk.

Muthiah Vaduganathan receives research support from Harvard Catalyst and serves on advisory boards for Amgen, AstraZeneca, Baxter Healthcare, Bayer AG, and Boehringer Ingelheim.

Jorge Plutzky reports grants from Boehringer Ingelheim; and personal fees from Novo Nordisk, Merck, Janssen, and Amgen.

Vanita R. Aroda reports other from Adocia; personal fees from BD and Zafgen; grants from Calibra, Eisai, Theracos, Elcelyx, and Fractyl; grants and personal fees from AstraZeneca, Novo Nordisk, and Sanofi; and grants and other from Janssen.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. 1.
    Sarwar N, Gao P, Seshasai SR, Gobin R, Kaptoge S, Di Angelantonio E, et al. Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies. Lancet. 2010;375(9733):2215–22.  https://doi.org/10.1016/S0140-6736(10)60484-9.CrossRefPubMedGoogle Scholar
  2. 2.
    Low Wang CC, Hess CN, Hiatt WR, Goldfine AB. Clinical update: cardiovascular disease in diabetes mellitus: atherosclerotic cardiovascular disease and heart failure in type 2 diabetes mellitus - mechanisms, management, and clinical considerations. Circulation. 2016;133(24):2459–502.  https://doi.org/10.1161/CIRCULATIONAHA.116.022194.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Ali MK, Bullard KM, Gregg EW. Achievement of goals in U.S. diabetes care, 1999-2010. N Engl J Med. 2013;369(3):287–8.  https://doi.org/10.1056/NEJMc1306652.CrossRefPubMedGoogle Scholar
  4. 4.
    Gregg EW, Hora I, Benoit SR. Resurgence in diabetes-related complications. JAMA. 2019.  https://doi.org/10.1001/jama.2019.3471.CrossRefGoogle Scholar
  5. 5.
    Gaede P, Vedel P, Larsen N, Jensen GV, Parving HH, Pedersen O. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. N Engl J Med. 2003;348(5):383–93.  https://doi.org/10.1056/NEJMoa021778348/5/383.CrossRefPubMedGoogle Scholar
  6. 6.
    Bittner V, Bertolet M, Barraza Felix R, Farkouh ME, Goldberg S, Ramanathan KB, et al. Comprehensive cardiovascular risk factor control improves survival: the BARI 2D trial. J Am Coll Cardiol. 2015;66(7):765–73.  https://doi.org/10.1016/j.jacc.2015.06.019.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Zinman B, Wanner C, Lachin JM, Fitchett D, Bluhmki E, Hantel S, et al. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Engl J Med. 2015;373(22):2117–28.  https://doi.org/10.1056/NEJMoa1504720.CrossRefPubMedGoogle Scholar
  8. 8.
    Marso SP, Daniels GH, Brown-Frandsen K, Kristensen P, Mann JF, Nauck MA, et al. Liraglutide and cardiovascular outcomes in type 2 diabetes. N Engl J Med. 2016;375(4):311–22.  https://doi.org/10.1056/NEJMoa1603827.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Neal B, Perkovic V, Matthews DR. Canagliflozin and cardiovascular and renal events in type 2 diabetes. N Engl J Med. 2017;377(21):2099.  https://doi.org/10.1056/NEJMc1712572.CrossRefPubMedGoogle Scholar
  10. 10.
    Marso SP, Holst AG, Vilsboll T. Semaglutide and cardiovascular outcomes in patients with type 2 diabetes. N Engl J Med. 2017;376(9):891–2.  https://doi.org/10.1056/NEJMc1615712.CrossRefPubMedGoogle Scholar
  11. 11.
    Hernandez AF, Green JB, Janmohamed S, D’Agostino RB Sr, Granger CB, Jones NP, et al. Albiglutide and cardiovascular outcomes in patients with type 2 diabetes and cardiovascular disease (Harmony Outcomes): a double-blind, randomised placebo-controlled trial. Lancet. 2018;392(10157):1519–29.  https://doi.org/10.1016/S0140-6736(18)32261-X.CrossRefPubMedGoogle Scholar
  12. 12.
    Wiviott SD, Raz I, Bonaca MP, Mosenzon O, Kato ET, Cahn A, et al. Dapagliflozin and cardiovascular outcomes in type 2 diabetes. N Engl J Med. 2019;380(4):347–57.  https://doi.org/10.1056/NEJMoa1812389.CrossRefPubMedGoogle Scholar
  13. 13.
    •• Perkovic V, Jardine MJ, Neal B, Bompoint S, Heerspink HJL, Charytan DM, et al. Canagliflozin and renal outcomes in type 2 diabetes and nephropathy. N Engl J Med. 2019;380(24):2295–306.  https://doi.org/10.1056/NEJMoa1811744. This study demonstrated significant renal risk reduction with canagliflozin in patients with T2D and stage 2 to 3 chronic kidney disease (CKD) with baseline albuminuria on maximally tolerated angiotensin-converting enzyme inhibitor or angiotensin II receptor blockers. CrossRefPubMedGoogle Scholar
  14. 14.
    Gerstein HC, Colhoun HM, Dagenais GR, Diaz R, Lakshmanan M, Pais P, et al. Dulaglutide and cardiovascular outcomes in type 2 diabetes (REWIND): a double-blind, randomised placebo-controlled trial. Lancet. 2019.  https://doi.org/10.1016/S0140-6736(19)31149-3.CrossRefGoogle Scholar
  15. 15.
    Wanner C, Inzucchi SE, Zinman B. Empagliflozin and progression of kidney disease in type 2 diabetes. N Engl J Med. 2016;375(18):1801–2.  https://doi.org/10.1056/NEJMc1611290.CrossRefPubMedGoogle Scholar
  16. 16.
    Zelniker TA, Wiviott SD, Raz I, Im K, Goodrich EL, Bonaca MP, et al. SGLT2 inhibitors for primary and secondary prevention of cardiovascular and renal outcomes in type 2 diabetes: a systematic review and meta-analysis of cardiovascular outcome trials. Lancet. 2018;393(10166):31–9.  https://doi.org/10.1016/S0140-6736(18)32590-X.CrossRefPubMedGoogle Scholar
  17. 17.
    McMurray JJV, Solomon SD, Inzucchi SE, Kober L, Kosiborod MN, Martinez FA, et al. Dapagliflozin in patients with heart failure and reduced ejection fraction. N Engl J Med. 2019;381:1995–2008.  https://doi.org/10.1056/NEJMoa1911303.CrossRefGoogle Scholar
  18. 18.
    Pfeffer MA, Claggett B, Diaz R, Dickstein K, Gerstein HC, Kober LV, et al. Lixisenatide in patients with type 2 diabetes and acute coronary syndrome. N Engl J Med. 2015;373(23):2247–57.  https://doi.org/10.1056/NEJMoa1509225.CrossRefPubMedGoogle Scholar
  19. 19.
    Holman RR, Bethel MA, Mentz RJ, Thompson VP, Lokhnygina Y, Buse JB, et al. Effects of once-weekly exenatide on cardiovascular outcomes in type 2 diabetes. N Engl J Med. 2017;377(13):1228–39.  https://doi.org/10.1056/NEJMoa1612917.CrossRefPubMedGoogle Scholar
  20. 20.
    Husain M, Birkenfeld AL, Donsmark M, Dungan K, Eliaschewitz FG, Franco DR, et al. Oral semaglutide and cardiovascular outcomes in patients with type 2 diabetes. N Engl J Med. 2019;381(9):841–51.  https://doi.org/10.1056/NEJMoa1901118.CrossRefPubMedGoogle Scholar
  21. 21.
    Davies MJ, D’Alessio DA, Fradkin J, Kernan WN, Mathieu C, Mingrone G, et al. Management of hyperglycemia in type 2 diabetes, 2018. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2018;41(12):2669–701.  https://doi.org/10.2337/dci18-0033.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    American Diabetes Association. 9. Pharmacologic approaches to glycemic treatment: standards of medical care in diabetes-2019. Diabetes Care. 2019;42(Suppl 1):S90–S102.  https://doi.org/10.2337/dc19-S009.CrossRefGoogle Scholar
  23. 23.
    Garber AJ, Abrahamson MJ, Barzilay JI, Blonde L, Bloomgarden ZT, Bush MA, et al. Consensus statement by the American Association of Clinical Endocrinologists and American College of Endocrinology on the comprehensive type 2 diabetes management algorithm - 2019 executive summary. Endocr Pract. 2019;25(1):69–100.  https://doi.org/10.4158/CS-2018-0535.CrossRefPubMedGoogle Scholar
  24. 24.
    Das SR, Everett BM, Birtcher KK, Brown JM, Cefalu WT, Januzzi JL Jr, et al. 2018 ACC expert consensus decision pathway on novel therapies for cardiovascular risk reduction in patients with type 2 diabetes and atherosclerotic cardiovascular disease: a report of the American College of Cardiology Task Force on expert consensus decision pathways. J Am Coll Cardiol. 2018;72(24):3200–23.  https://doi.org/10.1016/j.jacc.2018.09.020.CrossRefPubMedGoogle Scholar
  25. 25.
    Arnett DK, Blumenthal RS, Albert MA, Buroker AB, Goldberger ZD, Hahn EJ, et al. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. J Am Coll Cardiol. 2019.  https://doi.org/10.1016/j.jacc.2019.03.010.CrossRefGoogle Scholar
  26. 26.
    Dunlay SM, Givertz MM, Aguilar D, Allen LA, Chan M, Desai AS, et al. Type 2 diabetes mellitus and heart failure: a scientific statement from the American Heart Association and the Heart Failure Society of America. Circulation. 2019.  https://doi.org/10.1161/CIR.0000000000000691.
  27. 27.
    Seferovic PM, Ponikowski P, Anker SD, Bauersachs J, Chioncel O, Cleland JGF, et al. Clinical practice update on heart failure 2019: pharmacotherapy, procedures, devices and patient management. An expert consensus meeting report of The Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail. 2019.  https://doi.org/10.1002/ejhf.1531.CrossRefGoogle Scholar
  28. 28.
    Cosentino F, Grant PJ, Aboyans V, Bailey CJ, Ceriello A, Delgado V, et al. 2019 ESC guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Eur Heart J. 2019.  https://doi.org/10.1093/eurheartj/ehz486
  29. 29.
    Arnold SV, Inzucchi SE, Tang F, McGuire DK, Mehta SN, Maddox TM, et al. Real-world use and modeled impact of glucose-lowering therapies evaluated in recent cardiovascular outcomes trials: an NCDR(R) research to practice project. Eur J Prev Cardiol. 2017;24(15):1637–45.  https://doi.org/10.1177/2047487317729252.CrossRefPubMedGoogle Scholar
  30. 30.
    Vaduganathan M, Sathiyakumar V, Singh A, McCarthy CP, Qamar A, Januzzi JL Jr, et al. Prescriber patterns of SGLT2i after expansions of U.S. Food and Drug Administration labeling. J Am Coll Cardiol. 2018;72(25):3370–2.  https://doi.org/10.1016/j.jacc.2018.08.2202.CrossRefPubMedGoogle Scholar
  31. 31.
    Arnold SV, de Lemos JA, Rosenson RS, Ballantyne CM, Liu Y, Mues KE, et al. Use of guideline-recommended risk-reduction strategies among patients with diabetes and atherosclerotic cardiovascular disease: insights from Getting to an Improved Understanding of Low-Density Lipoprotein Cholesterol and Dyslipidemia Management (GOULD). Circulation. 2019.  https://doi.org/10.1161/CIRCULATIONAHA.119.041730.CrossRefGoogle Scholar
  32. 32.
    Vaduganathan M, Patel RB, Singh A, McCarthy CP, Qamar A, Januzzi JL Jr, et al. Prescription of glucagon-like peptide-1 receptor agonists by cardiologists. J Am Coll Cardiol. 2019;73(12):1596–8.  https://doi.org/10.1016/j.jacc.2019.01.029.CrossRefPubMedGoogle Scholar
  33. 33.
    Lu H, Holt JB, Cheng YJ, Zhang X, Onufrak S, Croft JB. Population-based geographic access to endocrinologists in the United States, 2012. BMC Health Serv Res. 2015;15:541–13.  https://doi.org/10.1186/s12913-015-1185-5.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Margolis KL, Asche SE, Bergdall AR, Dehmer SP, Groen SE, Kadrmas HM, et al. Effect of home blood pressure telemonitoring and pharmacist management on blood pressure control: a cluster randomized clinical trial. JAMA. 2013;310(1):46–56.  https://doi.org/10.1001/jama.2013.6549.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Fisher NDL, Fera LE, Dunning JR, Desai S, Matta L, Liquori V, et al. Development of an entirely remote, non-physician led hypertension management program. Clin Cardiol. 2019;42(2):285–91.  https://doi.org/10.1002/clc.23141.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Benson MD, McPartlin M, Matta L, Barclay KC, Bui TV, Blackburn RW, et al. A remote lipid management program improves appropriate statin use and cholesterol levels across a wide population of high cardiovascular risk patients. J Am Coll Cardiol. 2018;71(11):A1762.CrossRefGoogle Scholar
  37. 37.
    Eckel RH, Blaha MJ. Cardiometabolic medicine: a call for a new subspeciality training track in internal medicine. Am J Med. 2019.  https://doi.org/10.1016/j.amjmed.2019.02.027.CrossRefGoogle Scholar
  38. 38.
    Chan PS, Oetgen WJ, Buchanan D, Mitchell K, Fiocchi FF, Tang F, et al. Cardiac performance measure compliance in outpatients: the American College of Cardiology and National Cardiovascular Data Registry’s PINNACLE (Practice Innovation And Clinical Excellence) program. J Am Coll Cardiol. 2010;56(1):8–14.  https://doi.org/10.1016/j.jacc.2010.03.043.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Seferovic JP, Claggett B, Seidelmann SB, Seely EW, Packer M, Zile MR, et al. Effect of sacubitril/valsartan versus enalapril on glycaemic control in patients with heart failure and diabetes: a post-hoc analysis from the PARADIGM-HF trial. Lancet Diabetes Endocrinol. 2017;5(5):333–40.  https://doi.org/10.1016/S2213-8587(17)30087-6.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Centers for Disease Control and Prevention National Diabetes Statistics Report, 2017: Estimates of diabetes and Its burden in the United States; 2017. https://www.cddc.gov/diabetes/pdfs/data/statistics/nationa-diabetes-statistics-report.pdf. Accessed 15 Nov 2019.
  41. 41.
    Faillie JL, Yu OH, Yin H, Hillaire-Buys D, Barkun A, Azoulay L. Association of bile duct and gallbladder diseases with the use of incretin-based drugs in patients with type 2 diabetes mellitus. JAMA Intern Med. 2016;176(10):1474–81.  https://doi.org/10.1001/jamainternmed.2016.1531.CrossRefPubMedGoogle Scholar
  42. 42.
    Nauck MA, Muus Ghorbani ML, Kreiner E, Saevereid HA, Buse JB. Effects of liraglutide compared with placebo on events of acute gallbladder or biliary disease in patients with type 2 diabetes at high risk for cardiovascular events in the LEADER randomized trial. Diabetes Care. 2019.  https://doi.org/10.2337/dc19-0415.CrossRefGoogle Scholar
  43. 43.
    Bersoff-Matcha SJ, Chamberlain C, Cao C, Kortepeter C, Chong WH. Fournier gangrene associated with sodium-glucose cotransporter-2 inhibitors: a review of spontaneous postmarketing cases. Ann Intern Med. 2019;170(11):764–9.  https://doi.org/10.7326/M19-0085.CrossRefPubMedGoogle Scholar
  44. 44.
    Cherney DZ, Udell JA. Use of sodium glucose cotransporter 2 inhibitors in the hands of cardiologists: with great power comes great responsibility. Circulation. 2016;134(24):1915–7.  https://doi.org/10.1161/CIRCULATIONAHA.116.024764.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Lee-Shing Chang
    • 1
    Email author
  • Muthiah Vaduganathan
    • 2
  • Jorge Plutzky
    • 2
  • Vanita R. Aroda
    • 1
  1. 1.Division of Endocrinology, Diabetes, and HypertensionBrigham and Women’s HospitalBostonUSA
  2. 2.Division of Cardiovascular MedicineBrigham and Women’s HospitalBostonUSA

Personalised recommendations