Prescribing Paradigm Shift? Applying the 2019 European Society of Cardiology-Led Guidelines on Diabetes, Prediabetes, and Cardiovascular Disease to Assess Eligibility for Sodium-Glucose Cotransporter 2 Inhibitors or Glucagon-Like Peptide 1 Receptor Agonists as First-Line Monotherapy (or Add-on to Metformin Monotherapy) in Type 2 Diabetes in Scotland.

Autor:	Caparrotta, Thomas M., Blackbourn, Luke A.K., McGurnaghan, Stuart J., Chalmers, John, Lindsay, Robert, McCrimmon, Rory, McKnight, John, Wild, Sarah, Petrie, John R., Philip, Sam, McKeigue, Paul M., Webb, David J., Sattar, Naveed, Colhoun, Helen M., Scottish Diabetes Research Network–Epidemiology Group
Předmět:	SODIUM-glucose cotransporter 2 inhibitors GLUCAGON-like peptide-1 agonists GLUCAGON-like peptide 1 PEPTIDE receptors GLYCOSYLATED hemoglobin CARDIOVASCULAR diseases CARDIOLOGY CROSS-sectional method PATIENT selection HYPOGLYCEMIC agents HISTORY ACQUISITION of data RETROSPECTIVE studies MEDICAL protocols TYPE 2 diabetes RISK assessment MEDICAL societies
Zdroj:	Diabetes Care; Sep2020, Vol. 43 Issue 9, p2034-2041, 8p
Abstrakt:	Objective: In 2019, the European Society of Cardiology led and released new guidelines for diabetes cardiovascular risk management, reflecting recent evidence of cardiovascular disease (CVD) reduction with sodium-glucose cotransporter 2 inhibitors (SGLT-2is) and some glucagon-like peptide 1 receptor agonists (GLP-1RAs) in type 2 diabetes (T2D). A key recommendation is that all those with T2D who are (antihyperglycemic) drug naïve or on metformin monotherapy should be CVD risk stratified and an SGLT-2i or a GLP-1RA initiated in all those at high or very high risk, irrespective of glycated hemoglobin. We assessed the impact of these guidelines in Scotland were they introduced as is.Research Design and Methods: Using a nationwide diabetes register in Scotland, we did a cross-sectional analysis, using variables in our register for risk stratification at 1 January 2019. We were conservative in our definitions, assuming the absence of a risk factor where data were not available. The risk classifications were applied to people who were drug naïve or on metformin monotherapy and the anticipated prescribing change calculated.Results: Of the 265,774 people with T2D in Scotland, 53,194 (20.0% of those with T2D) were drug naïve, and 56,906 (21.4%) were on metformin monotherapy. Of these, 74.5% and 72.4%, respectively, were estimated as at least high risk given the guideline risk definitions.Conclusions: Thus, 80,830 (30.4%) of all those with T2D (n = 265,774) would start one of these drug classes according to table 7 and figure 3 of the guideline. The sizeable impact on drug budgets, enhanced clinical monitoring, and the trade-off with reduced CVD-related health care costs will need careful consideration. [ABSTRACT FROM AUTHOR]
Databáze:	Complementary Index
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