- Updated recommendations for diabetes and cardiovascular disease (CVD) offer recommendations on using sodium-glucose co-transporter-2 inhibitors (SGLT2is) and glucagon-like peptide-1 receptor antagonists (GLP-1RAs).
- The complete guidelines are available here; the European Society of Cardiology (ESC) also offers clinicians a pocket version or the ESC mobile pocket guidelines app.
Why this matters
- The guidelines provide “state-of-the-art” information based on new data since the 2013 version, said task force chair Francesco Cosentino in a statement.
- New additions to the recommendations are listed here.
- Class I additions include using resting ECGs to assess risk in patients with diabetes and hypertension or suspected CVD and applying lifestyle changes as prevention against progression from prediabetes.
- Changes from the 2013 guidelines are listed here.
- Clinicians can find a summary of what to do and what not to do here.
- The task force collated some key messages for each area the guidelines address, including:
- Cardiovascular risk assessment: assess microalbuminuria to identify renal dysfunction/CVD risk.
- Primary prevention, CVD: emphasize lifestyle changes.
- CVD: GLP-1RAs or SGLT2is should be first-line treatment with established CVD or high risk for CVD.
- Glucose control: tight control in younger patients has long-term cardiovascular benefits, but personalize targets for, e.g., older patients, those with advanced CVD.
- BP: target systolic 130 mmHg, no lower than 120 mmHg, personalize as warranted; dual therapy is recommended first-line.
- Lipids: statins are state of the art but should be used with caution in women of childbearing age, young people.
- Heart failure: in first-line treatment for diabetes with HF, include metformin, SGLT2is.
- This article provides only highlights, and clinicians should consult the complete guidelines for details.