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Cardio Metabolic Health Congress – Official Blog

SGLT-2 inhibitors Associated with Decreased HF Hospitalizations in Type 2 Diabetes

The management of patients with type 2 diabetes (T2D) and heart failure (HF) is challenging, and the optimal care for these patients is not very well defined. The coexistence of these two conditions increases morbidity and mortality. Patients with HF and T2D are at an increased risk for cardiovascular-related mortality and have higher rates of HF hospitalizations. Almost a quarter of all HF patients are readmitted to the hospital within 30 days of discharge; nearly half are hospitalized 4 or more times, and these patients often have cardiometabolic comorbidities—furthering the risks of hospitalization and readmission. Glycemic control in patients with T2D and HF can be complex for clinicians, for example, thiazolidinediones are known to increase HF risk. However, recent studies have suggested that newer antihyperglycemic medications, particularly SGLT-2 inhibitors, can improve HF risk and reduce hospitalizations for HF in T2D.

Data from the cardiovascular outcome trials (CVOTs) of antidiabetic drugs have not only revealed exciting information about cardiovascular and renal benefits of the newer drugs, but also about HF risk in T2D. A recent meta-analysis of nine CVOTs that included 87,162 subjects showed that SGLT-2 inhibitors are associated with a decreased risk of HF hospitalizations compared with placebo. In addition, GLP-1 agonists and DPP-4 inhibitors were not associated with a significant risk reduction in HF hospitalization rates. In a class ranking, the authors reported that with 99.6% probability, SGLT-2 inhibitors are the most effective drugs to reduce the risk of HF hospitalizations in patients with T2D, followed by GLP-1 agonist and DPP-4 inhibitors. The meta-analysis included SGLT-2 inhibitors empagliflozin and canagliflozin, GLP-1 agonists lixisenatide, liraglutide, semaglutide, and once-weekly exenatide, and DPP-4 inhibitors alogliptin, saxagliptin, and sitagliptin.

Interestingly, no association was found between heart failure risk and a lowering of HbA1c targets over time in the trial participants. This seems to suggest that in T2D patients with specific comorbidities, such as heart failure or cardiovascular disease, certain drug classes are emerging as having a more favorable profile, which will enable clinicians to better tailor therapy to address these risks rather than focusing heavily on HbA1c targets. This line of thinking is also currently reflected in the draft ADA/EASD guidelines for the management of hyperglycemia in T2D presented at the 2018 ADA conference in Orlando.

This study provides important information about the HF safety and benefits of SGLT-2 inhibitors in T2D. Ongoing CVOTs and studies in HF-specific populations with drugs of this class will provide additional information about their utility in this setting.

References:
Kramer, Caroline K., et al. “Comparison of New Glucose-Lowering Drugs on Risk of Heart Failure in Type 2 Diabetes: A Network Meta-Analysis.” JACC: Heart Failure (2018): 912.
American Diabetes Association (ADA) 2018 Scientific Sessions. “Management of Hyperglycemia in Type 2 Diabetes – Draft ADA/EASD Consensus Report 2018.” June 26, 2018.

Applications of Digital Health Technologies

The primary issue that consumes the majority of the burden of healthcare costs in the United States is preventable chronic disease: while the most prevalent health conditions are simultaneously the most avoidable, they continue to cost the country’s budget billions of dollars. While overall numbers have decreased since 2010, when chronic disease cost the U.S. a total of $315 billion, morbid obesity rates have continued to rapidly spike—a condition that leads to a range of critical health issues including heart disease, diabetes, and stroke.

Primary care providers have long faced the struggle of determining how to implement best practice care for patients diagnosed with chronic diseases. Recent studies indicate that almost half of the entire U.S. population has at least one chronic health condition—including heart disease, cancer, diabetes, obesity, or arthritis. Statistics designate these health care treatments costs to account for 86% of cumulative national healthcare spending, and the CDC reports that chronic conditions are the leading causes of death and disability in the country.

Yet the past decade has seen the advent and proliferation of digital health technology, spurring the generation of new techniques and strategies for healthcare professionals to utilize in chronic disease management. These types of technology vary in terms of accessibility and usability, but include remote monitoring, mobile health apps installable on phones, and wireless wearables—which serve as activity trackers.

A series of interviews conducted by Medical News Today demonstrate a bright future for the potential of new technology, and its ability to spur and provide high-quality care. Suzanne Falck, MD, an associate professor of internal medicine at the University of Illinois College of Medicine, noted that a highly successful digital tool is currently in use for the management of heart failure: an implanted sensor immediately transmits data to a healthcare practitioner, who then analyzes the data in order to make medical recommendations. Further clinical trials and studies indicate that remote monitoring is more cost-effective than traditional, conventional management.

Moreover, the burgeoning popularity of medical apps signifies that mobile technology can make a hugely positive impact on chronic disease management. There are currently approximately 259,000 medical health apps available to purchase; over half are aimed at targeting consumers with chronic conditions. Clinical trials have repeatedly shown that patients with type 2 diabetes who utilized an app to monitor their blood glucose levels showed greater benefits than those who did not. An article in Diabetes Technology & Therapeutics states that the prognosis in patients with diabetes is ‘strongly influenced by the degree of control of their disease,’ which reinforces the effectiveness of self-management support through mobile apps.

Another innovative and exciting development is the increasing amount of wearable technology and devices, which are currently being studied in a variety of clinical research settings. Many healthcare providers believe that the ‘potential of this technology is endless,’ as they can improve access to care while simultaneously enhancing convenience—and likely patient compliance. Most importantly, being conscious of medicinal needs and treatments requires a consistently high level of responsibility and awareness.

Healthcare experts urge patients to take active, informed roles in managing their health: online workshops have been developed to offer chronic disease self-management programs, which have been proven to significantly improve health statuses. Moreover, healthcare practitioners and professionals must collectively work together and utilize the new landscape of digital medical technology to their patients’ benefits.

In order to assist and educate healthcare practitioners and professionals surrounding the rapidly evolving field of digital technology, CMHC connects technologies to patient care and outcomes. Hosted in collaboration with the American Medical Association, our Small Group Workshops at the 13th Annual CMHC titled Real World Digital Health Implementations to Improve Blood Pressure Control and Prevent Type 2 Diabetes with Digital Health: Effective and Realistic Solutions will focus on the applications of digital health technologies to cardiometabolic health, and chronic disease. Learn more here.

REFERENCES
https://mhealthintelligence.com/news/are-healthcare-providers-getting-comfortable-with-telehealth
https://www.acc.org/latest-in-cardiology/articles/2018/01/04/12/42/cover-story-digital-health-solutions-in-cardiovascular-medicine