Evidence supporting the multiple clinical benefits of SGLT2 inhibitors and GLP-1 receptor agonists has outpaced their effective implementation in clinical practice, according to the American Heart Association.
An AHA scientific statement, Cardiorenal Protection With the Newer Antidiabetic Agents in Patients With Diabetes and Chronic Kidney Disease, said the antihyperglycaemic agents are typically only initiated by GPs or endocrinologists for their patients with diabetes.
Yet the evidence is clear that they also have a role beyond diabetes.
“Given the well-proven CVD and CKD benefits from these drug classes in RCTs, there is an urgent need to incorporate multidisciplinary care in the identification of high-risk patients who may benefit from these agents.”
The AHA called for multidisciplinary efforts from primary care physicians, cardiologists, nephrologists, endocrinologists, pharmacists, advanced practitioners, and other allied health professionals toward providing targeted therapies for CVD and CKD risk reduction in patients with T2D.
As an example of the growing evidence for the agents, the DAPA-CKD trial has recently reported that dapagliflozin significantly reduces the risk of a composite of a sustained decline in the estimated GFR of at least 50%, end-stage kidney disease, or death from renal or cardiovascular causes in patients with chronic kidney disease, regardless of the presence or absence of diabetes.
The RCT, published in the NEJM, comprised more than 4,000 patients from 386 sites across 21 countries randomised to either dapagliflozin (10 mg once daily) or placebo.
The primary composite outcome occurred in 9.2% of the dapagliflozin group compared to 14.5% in the control group (HR 0.61; p<0.001). The event rates for all individual components of the composite outcome also favoured dapagliflozin.