Diabetes

  • Type 2 diabetes is a major risk factor for the development of cardiovascular disease and cerebrovascular incidents. A substantial body of evidence has demonstrated that the proper management of blood glucose in people with diabetes can inhibit the progression of microvascular diseases such as retinopathy and nephropathy.

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    Type 2 diabetes is a major risk factor for the development of cardiovascular disease and cerebrovascular incidents. A substantial body of evidence has demonstrated that the proper management of blood glucose in people with diabetes can inhibit the progression of microvascular diseases such as retinopathy and nephropathy.

    In the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial, the overall mortality significantly increased by strict control of blood glucose (target HbA1c <6%) compared with a less stringent control (target HbA1c of approximately 7%). Strict glucose control resulted in a significantly higher likelihood of developing severe hypoglycaemia, while severe hypoglycaemia was itself associated with death due to CVD.

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Type 2 Diabetes (T2D)

Type 2 Diabetes Mellitus

CV Outcomes in Diabetes

Risk reduction with antihyperglycemics

Cardiovascular (CV) disease remains the leading cause of morbidity and mortality in patients with type 2 diabetes (T2D).

The opportunity for CV disease prevention in patients with T2D has recently expanded with antihyperglycemic agents demonstrating significant reductions in the risk of major adverse cardiovascular events (MACE). Although the exact mechanisms of CV benefit remain uncertain, they appear to be unrelated to the direct glucose-lowering effects. These agents have triggered a shift beyond glucose control, to a broader strategy of comprehensive CV risk reduction.

CV specialists are well-positioned to play a key role in managing patients with T2D including screening, aggressively treating CV risk factors, and incorporating the use of antihyperglycemic agents into routine practice.


The Radcliffe diabetes and CVD risk program is supported by an educational grant from Novo Nordisk.

novo nordisk

Section Editor

Professor Mikhail N Kosiborod

Saint Luke's America Heart Institute, Kansas City, MO, US

  • Heart Failure Association of the European Society

    HFA recommends canagliflozin, dapagliflozin empagliflozin or ertugliflozin for the prevention of HF hospitalisation in patients with T2D and established CVD or at high CV risk. Dapagliflozin or empagliflozin are recommended to reduce the HF...

    Seferovic PM, Fragasso G, Petrie M, et al. Eur J Heart Fail 2020; epub ahead of press.
  • Effect of empagliflozin on the clinical stability

    In patients with HF and a reduced ejection fraction, empagliflozin reduced the risk and total number of worsening HF events, with benefits seen early after initiation of treatment and sustained for the duration of double-blind therapy.

    Packer M, Anker SD, Butler J et al. Circulation 2020; epub ahead of press.
  • What makes sodium-glucose co-transporter-2

    The authors outline the unique properties of SGLT-2 inhibitors which may lend favorably to their efficient integration into HF therapy. They discuss dosing, effects on kidney function and electrolytes, diuretic activity and safety.

    Khan MS, Vaduganathan M. Curr Diab Rep 2020;20:63.
  • Effects of canagliflozin on amino-terminal

    A substantial percentage of patients in the CANVAS trial had elevated NT-proBNP. Canagliflozin reduced NT-proBNP versus placebo; however, reduction in NT-proBNP explained only a small proportion of the benefit of canagliflozin on HF events.

    Januzzi JL Jr, Xu J, Li J, et al. J Am Coll Cardiol 2020;76:2076–85.

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