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2.
J Am Heart Assoc ; 10(13): e021084, 2021 07 06.
Article in English | MEDLINE | ID: mdl-33998258

ABSTRACT

Background SGLT-2 (sodium glucose transporter-2) inhibitors and GLP-1RAs (glucagon-like peptide-1 receptor agonists) effectively lowered cardiovascular risk in large clinical trials for patients with type 2 diabetes mellitus at high risk for these complications, and have been recommended by guidelines. To evaluate the contemporary landscape in which these recommendations would be implemented, we examined the use of these medications according to clinical guideline practice. Methods and Results In the National Health and Nutrition Examination Survey for 2017 to 2018, we defined compelling indications for SGLT-2 inhibitors by the presence of atherosclerotic cardiovascular disease, heart failure, or chronic kidney disease, and for GLP-1RAs by the presence of established or high-risk atherosclerotic cardiovascular disease, based on large clinical trials that have been incorporated in guideline recommendations of the American College of Cardiology and American Diabetes Association. We then evaluated use of these medications among patients with physician-diagnosed type 2 diabetes mellitus. All analyses incorporated complex survey design to produce nationally representative estimates. A total 1104 of 9254 sampled individuals had type 2 diabetes mellitus, representing 10.6% (95% CI, 9.7%-11.6%) of the US population or 33.2 million adults nationally. Of these, 52.6% (95% CI, 47.7%-57.5%) had an indication for SGLT-2 inhibitors, 32.8% (95% CI, 28.8%-37.2%) for GLP-1RAs, and 26.6% (95% CI, 22.2%-31.7%) for both medications. During 2017 to 2018, 4.5% (95% CI, 2.4%-8.2%) were treated with SGLT-2 inhibitors and 1.5% (95% CI, 0.7%-3.2%) with GLP-1RAs. Atherosclerotic cardiovascular disease, heart failure, or chronic kidney disease were not independently associated with SGLT-2 inhibitor or GLP-1RA use in patients with diabetes mellitus. Conclusions Despite a large number of patients being eligible for guideline-recommended cardiorenal protective therapies, there are substantial gaps in the use of SGLT-2 inhibitors and GLP-1RAs, limiting their public health benefits.


Subject(s)
Blood Glucose/drug effects , Cardiovascular Diseases/prevention & control , Diabetes Mellitus, Type 2/drug therapy , Eligibility Determination/trends , Glucagon-Like Peptide-1 Receptor/agonists , Incretins/therapeutic use , Practice Patterns, Physicians'/trends , Sodium-Glucose Transporter 2 Inhibitors/therapeutic use , Aged , Biomarkers/blood , Blood Glucose/metabolism , Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/epidemiology , Diabetes Mellitus, Type 2/blood , Diabetes Mellitus, Type 2/diagnosis , Diabetes Mellitus, Type 2/epidemiology , Drug Utilization/trends , Female , Guideline Adherence/trends , Heart Disease Risk Factors , Humans , Incretins/adverse effects , Male , Middle Aged , Nutrition Surveys , Practice Guidelines as Topic , Risk Assessment , Sodium-Glucose Transporter 2 Inhibitors/adverse effects , Time Factors , Treatment Outcome , United States/epidemiology
3.
Cureus ; 12(12): e12295, 2020 Dec 26.
Article in English | MEDLINE | ID: mdl-33520499

ABSTRACT

The novel severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) which results in coronavirus disease 2019 (COVID-19) has had a devastating impact globally. Not much is fully understood about this disease. Acute respiratory distress syndrome (ARDS) appears to be the commonest complication among patients with COVID-19. However, venous thromboembolism (VTE) appears to be a common complication among patients with COVID-19 even with adequate anticoagulation during hospitalization. VTE may confer a poor outcome on its own or may exacerbate other common complications such as ARDS or cardiac injury. There are several diagnostic dilemmas with regards confirming VTE among patients with COVID-19 as there is a move to reduce the transfer of patients for angiographic studies or even venous Doppler ultrasonography because of the high transmissibility SARS-CoV-2. There is also the risk of worsening ARDS following fluid administration to prevent contrast nephropathy after angiographic studies.  It is, therefore, crucial to understand the timing of VTE occurrence in the setting of COVID-19, identify strategies for early diagnosis of VTE, therapeutic options as well as prognostic implications of VTE in the setting of COVID-19.

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