🔴 Time to implement the #4pillars of “kidney GDMT”

✅RAS blockade
✅SGLT2i
✅ns-MRA
✅GLP-1 RA

✅Lifetime cardiovascular, kidney & mortality benefits of combination therapy in people with diabetes with albuminuria

ahajournals.org/doi/10.1161/CI…
#CardioEd #Cardiology #CardioTwitter

🔴 Do #SGLT2i have a role in #CardioOnc ? This review article highlights the cardioprotective evidence and the anticancer potential of SGLT2i in cardio-oncology. bit.ly/4ccqRCd

#JACCCardioOnc #CardioEd #CardioTwitter #cardiology

GLP1RA + SGLT2i should be started early and often for people with T2D

Data is overwhelming at this point. Metformin should only precede these two if cost is an issue.

HFpEF vs HFmrEF management 🏥 via #esc2023 #EBM

🔑 Clinical Trials:

🔹DELIVER (2022) and EMPEROR-Preserved (2021): SGLT2i in EF>40%
🔹PARAGON-HF (2019): ARNI vs ARB in EF>45%
🔹TOPCAT (2014): MRA in EF>45%
🔹CHARM-Preserved (2003): ARB in EF>40%

App 🔗 apps.apple.com/us/app/cardiac…

💶💵 Cost-Effectiveness of Medical Therapy for HFmrEF/HFpEF

💊MRA
💊💊MRA + SGLT2i
💊💊💊 MRA + SGLT2i+ARNI

↗️ in life years of HFmrEF/HFpEF👥
💊1.04/0.99
2️⃣💊1.58/1.54
3️⃣💊1.80/1.77

💊MRA therapy ICERs of $10,000 per r
QALY in both subgroups
💊💊ICER $113,000 per QALY in the…

Real world data on #SGLT2i in advanced #CKD (eGFR below 20)

🔹Taiwan National Health Insurance Database

🔸76%⤵️ need for dialysis

🔹39%⤵️Acute MI💔

🔸20%⤵️AKI

🔹12%⤵️DKA‼️

⚠️residual bias may be present as RWE

🔗acpjournals.org/doi/10.7326/M2…

The one and only Dr. Mikhail Kosiborod presenting at the Annual Turning the Tide of Diabetes Meeting at EVMS. #SGLT2i #GLP1 #cardiometabolic #diabetes #obesity #HFpEF

DM CKD stage 5にSGLT2iは有用？
10.7326/M23-1874

末期腎不全患者のSGLT2iの長期アウトカムは？
↓
🇹🇼データベース研究
2型DMでCKD stage 5患者
SGLT2i使用vs非使用
透析、心血管イベント、死亡リスク比較

結果：SGLT2i使用で
―透析、心不全入院、AMI、DKA、AKI↓
―全死亡→

Cons of inpatient SGLT2i use. AACE
endocrinepractice.org/article/S1530-…

心不全に対する異なる💊SGLT2iの効果比較
- ⚡️観察研究
- 全死亡または入院の複合アウトカムを評価
- エンパグリフロジンはダパグリフロジンよりも有意に複合アウトカム減 32.2% vs 34.8% HR 0.90 (0.86-0.94)
- ただし全死亡は差なし HR 0.91 (0.82-1.00)
- メカニズムは不明
jamanetwork.com/journals/jaman…

Pros of inpatient SGLT2i use. AACE
endocrinepractice.org/article/S1530-…

SGLT2i safer than EPO for treatment of anemia in CKD ? What do you think ?

bit.ly/CJASN0362

Session: management of #obesity
🔥Holistic care is key! Listen & help those with obesity seeking support. Exercise, resistance training, diet, weight reduction, lifestyle and psychological input alongside medical therapies (SGLT2i & GLP-1/GP agonists +/- bariatric surgery

It’s great to be part of Turning the Tide on Diabetes Annual Meeting! Looking forward to next year! #diabetes #HFpEF #obesity #CKD #cardiometabolic #statin #SGLT2i #GLP1 #diet #exercise #lifestyle

まいち それではSGLT2iのトピックに絞りますが

「SGLT2i服用者すでに糖尿病を患っていて肝腎の機能が低下している」
「SGLT2i服用者の食事はカロリー制限食(not高脂肪)」

対してケトジェニックダイエット(KD)は肥満体ではあれど肝腎は健全な状態で行われる

この条件ではKDでかえって脂肪肝が誘発される

まいち dmic.ncgm.go.jp/general/about-…

糖尿病の標準治療における食事療法は
糖質制限は行わず、バランス良くカロリーを抑えた食事を摂るもの

その状態でSGLT2iを投与されると脂肪肝が改善した、というデータであり
ダイエット目的の超低糖質高脂質食では
脂肪肝が悪化するデータも出ています

@dirkmullerwieland on 2023 European Society of Cardiology diabetes guidelines
➡️Focus on CV risk prevention not just glucose lowering
➡️Give all pts GLP-1 RA & SGLT2i
➡️Reduce CV and kidney risk in #diabetes & #CKD eGFr & ACR (albuminuria =kidney damage before eGFR declines)
➡️New T2DM risk score

Los SGLT2i aumentan el suministro cardíaco de O2 y energía y disminuyen el trabajo cardíaco y citotoxicidad. Hay menor formación de toxinas como el p-cresol. La pérdida urinaria de calorías y glucosa aumenta lipólisis, por lo tanto, reduce la masa grasa.

doi.org/10.1093/ndt/gf…

Sodium–Glucose Cotransporter-2 Inhibitors and the Risk for Dialysis and Cardiovascular Disease in Patients With Stage 5 Chronic Kidney Disease

SGLT2i use was associated with a lower risk for dialysis, cardiovascular events, DKA, and AKI

acpjournals.org/doi/10.7326/M2…

Join us this weekend for the Annual Turning the Tide on Diabetes Meeting. We have a great program and excellent speakers lineup! #CME #diabetes #SoMe #MedEd #heartfailure #SGLT2i #GLP1 #obesity #HFpEF #prevention