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246 Cardio Diabetes Medicine 2017

• Duration of DM – 8 years and drug administration criteria of safety with re-
spect to a composite cardio vascular outcome with
• Baseline HbA1 7-2
C no excess in rates of heart failure hospitalisation.
• Goal < 6-5
• The EMPA-REG outcomes study reported safety
• High risk for CVD and superiority of the SGLT-2 inhibitor EMPAGLI-
FLOZIN in individuals with type 2 DM and cardio-
• Hypoglycemia more in intensive arm, no reduction
in macrovascular disease vascular disease accompanied by marked reduc-
tion in cardiovascular and all-cause mortality.
• Gradual reduction in HbA1 (2years)
C • The US food and drug administration has approved
VADT TRIAL :- a new indication for LIRAGLUTIDE for reducing risk
4
• 1791 patients of MI, Stroke and cardiovascular death in adults
with type 2 DM who have established cardiovas-
• Mean age 60 years cular disease.
• Duration of DM- 11.5 years
TAKE HOME MESSAGES -
• Base line HbA1 9.4
C CARDIOLOGIST’S PERSPECTIVE:
• Goal <6 - More worried about hypoglycemia than hypergly-
• 40% had precious CV events cemia because it tilts the balance of a chronic as
well as acute cardiac patients suddenly.
• Hypoglycemia more, no difference in macro or mi-
cro vascular outcomes - Recognize that episode of severe hypoglycemia
are associated with increased all cause and cardio-
• Medium decrease in HbA1c vascular mortality in patients with T2DM.Various
UKPDS :- proinflammatory, prothrombotic, proatheroscle-
5
rotic and proarrythmogenic processes have been
- 5102 patients
suggested as potential mediators for the adverse
- Mean age 54 effects of hypoglycemia on the heart
- Newly diagnosed DM - To reduce macrovascular events or should aim at
gradual sugar lowering without precipitating hypo-
- Achieved HbA1c – 7
glycemia
- More hypoglycemia in patients with sulfonylurea - With the paucity of data in the ACS setting, a more
and insulin
conservative approach to glucose management
- No change in events at 7 years should be used for patients with ACS events. The
recommended glucose targets of below 180mg/dl
- Follow up further period of 9 years showed gradual 6
reduction in HbA1 with reduction in macrovascular are reasonable based on the existing data .
C
events. - Recognize that hypoglycemia is exceedingly com-
mon, and that this is usually attributable to sul-
DRUGS – HYPOGLYCEMIA AND CV EVENTS fonylurea and insulin therapy. Renal dysfunction
and older age are also important risk factors for
• Newer glucose lowering agents such as the incre-
tins(GLP receptor agonists and DPP-4 inhibitors) hypoglycemia
and SGLT2 inhibitor classes of agents are associat- - Metformin and DPP4 inhibitors produce less hypo-
ed with much lower rates of hypoglycemia relative glycemia and likely to be cardioprotective.
to sulfonylureas or insulin, and maybe considered
as preferred add on therapies to metformin in pa- - Welcome the drugs which produce less or no hy-
tients with DM poglycemia which are safe for the heart and at the
same time control macro and microvascular events
• During the review process, the primary results of significantly.
3 cardiovascular outcome trials in DM were pub-
lished. The TECOS and ELIXA studies demonstrat- CONCLUSION:
ed that the DPP-4 inhibitor SITAGLIPTIN and the Severe hypoglycemia represents a common and
GLP-1 receptor agonist LIXISENATIDE respectively challenging issue in the optimal management of car-
were non inferior to placebo and met the US food

GCDC 2017