This post was authored by Darren McGuire, MD, FACC, a member of the Diabetes Collaborative Registry Steering Committee.

Until recently, the impact of antihyperglycemic medications on cardiovascular disease has been relatively unclear. However, a new class of antihyperglycemic medications called sodium glucose co-transporter (SGLT) 2 inhibitors is showing promise as a means of treating cardiovascular disease in patients with type 2 diabetes, and may change the way we consider antihyperglycemic treatment options for such patients.

The striking (and surprising) results of the EMPA-REG OUTCOME trial were all the buzz at the 2015 European Association for the Study of Diabetes Annual Meeting in Stockholm this past September. Data showed that empagliflozin, plus standard care, lowered the rate of the primary composite outcome of time to the first occurrence of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke, in patients with type 2 diabetes and prevalent atherosclerotic cardiovascular disease at trial entry.

The key finding was a 38 percent relative reduction in cardiovascular death, which drove the overall 14 percent risk reduction in the primary 3-point composite outcome. Additionally, unlike some other cardiovascular studies in the past, there was no compensatory increase in in non-cardiovascular mortality. Complimenting these findings was a 35 percent relative risk reduction in heart failure hospitalization. Heart failure is a very important complication in patients with diabetes – one that has actually moved in the wrong direction with some diabetes drugs.

Additional findings from this study were presented today during AHA 2015 in Orlando, showing reduced heart failure (HF) hospitalization or cardiovascular death in type 2 diabetes patients with or without heart failure at baseline.

As we continue to progress into this somewhat unchartered territory of treating and managing hyperglycemia associated with diabetes to impact cardiovascular disease risk, it is imperative that professional organizations continue to consider how results such as those from the EMPA-REG OUTCOME trial, as well as the results of future trials, will affect future treatment guidelines for type 2 diabetes. Importantly, clinical trials are ongoing that will assess the cardiovascular effects of two other SGLT2 inhibitors – canagliflozin and dapagliflozin – with results expected in approximately two years. In addition, some 20 additional cardiovascular outcomes trials are ongoing or soon to begin that will assess numerous other antihyperglycemic therapies with regard to cardiovascular safety and efficacy. All told, these trials will comprise over 250,000 patients with diabetes.

The good news is that practices participating in the Diabetes Collaborative Registry can help inform insights and evidence-based decision making going forward. The registry, a collaboration between the ACC, the American Diabetes Association, the American College of Physicians, the American Association of Clinical Endocrinologists and Joslin Diabetes Center, is designed to serve as a real-world database that can provide a holistic picture of diabetes care across specialties in the U.S. Additionally, recently announced collaborations between PatientsLikeMe and National Heart Centre Singapore and the Diabetes Collaborative Registry will facilitate increased patient engagement in understanding diabetes, as well as compliment the Diabetes Collaborative Registry with information about diabetes patient care and outcomes in Asia, respectively. Learn more here.

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