Given the well-proven cardiovascular disease and chronic kidney disease (CKD) benefits from SGLT2 inhibitors and GLP-1 receptor agonists in patients with type 2 diabetes, there may be an urgent need to incorporate multidisciplinary care in the identification of high-risk patients who could benefit from these agents, according to a scientific statement from the American Heart Association published Sept. 28 in Circulation.

Janani Rangaswami, MD, et al., summarize current literature on the cardiorenal protective effects with SGLT2 inhibitors and GLP-1 receptor agonists in patients with CKD and type 2 diabetes, and review potential mechanistic pathways that may drive these benefits.

According to the authors, the advent of the newer classes of antihyperglycemic agents, including SGLT2 inhibitors and GLP-1 receptor agonists, has changed the landscape of therapeutic options for patients with CKD with type 2 diabetes. It has also demonstrated a significant reduction in cardiovascular adverse events and progression to end-stage kidney disease.

The authors note that several potential mechanisms exist through which these beneficial effects are achieved in both drug classes, which may be independent of their antihyperglycemic effects.

Also in the statement, the authors list several practical steps that may be undertaken to encourage safe and effective use of evidence-based antihyperglycemic therapies to lower cardiovascular disease and CKD risks, including identification of at-risk patients, selection of therapy, adjustment of concomitant therapies and deprescribing, patient counseling, and longitudinal follow-up.

Finally, as the broad health implications of type 2 diabetes are recognized, the authors explain that multispecialty care models help promote targeted and equitable integration of these evidence-based therapies in clinical care, especially with support from health care systems and payers.

"With multidisciplinary efforts from primary care physicians, cardiologists, nephrologists, endocrinologists, pharmacists, advanced practitioners and other allied health professionals toward providing targeted therapies for cardiovascular disease and CKD risk reduction in patients with type 2 diabetes, there is opportunity to meaningfully reduce morbidity, mortality and health care expenditures for this vulnerable patient population," the authors conclude.

Keywords: Hypoglycemic Agents, Diabetes Mellitus, Type 2, Cardiovascular Diseases, Physicians, Primary Care, Health Expenditures, Pharmacists, Renal Insufficiency, Chronic

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