ESC 2019 — New guidelines on diabetes and CVD tackle use of SGLT2is and GLP-1RAs

  • Emily Willingham, PhD
  • Conference Reports
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  • 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. 

Key highlights

  • 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.

Additional note