Heart Failure Studies Reflected in Updated ADA Standards

Updates reflect the increased intersection among diabetes, cardiovascular, and kidney disease care among certain drug classes, especially sodium glucose co-transporter 2 (SGLT2) inhibitors.

Standards of care from the American Diabetes Association (ADA) were updated last week to reflect studies from the past year involving therapies that reduce hospitalization for heart failure and delayed chronic kidney disease progression, including for patients with type 2 diabetes (T2D).

Updates reflect the increased intersection among diabetes, cardiovascular, and kidney disease care among certain drug classes, especially sodium glucose co-transporter 2 (SGLT2) inhibitors. New evidence included in the section on Cardiovascular Disease and Risk Management comes from cardiovascular outcomes trials: VERTIS-CV, for ertugliflozin; EMPEROR-Reduced, for empagliflozin; and SCORED and SOLOIST-WHF, for sotagliflozin, a dual SGLT1/2 inhibitor.

Additional results for SCORED and SOLOIST will be presented Tuesday during the 81st ADA Scientific Sessions. Previous results have shown a signal in heart failure with preserved ejection fraction, a hard-to-treat condition.

The section Microvascular Complications and Foot Care was updated to feature evidence from DAPA-CKD, for dapagliflozin, and FIDELIO-CKD, for finerenone.

Robert A. Gabbay, MD, PhD, FACP, chief scientific and medical officer for the ADA, said the evidence on SGLT2 inhibitors “continues to be confirmatory and expanding. We're seeing more confirmation that SGTL2 [inhibitors] reduce both cardiovascular disease and chronic kidney disease risk.”

In recent years, the ADA has moved away from updating the Standards of Medical Care in Diabetes once a year and instead adopted a Living Standards model, with frequent updates. These latest updates will be covered in talks during the 81st ADA Scientific Sessions this weekend.

“More evidence is accumulating that this effect is probably not about glucose, or certainly not totally based on blood glucose changes, and that other important mechanisms are involved,” he said. “Part of that evidence is the fact that seeing benefit of these medications in people without diabetes, and that is an exciting, new arena and something that you'll see covered in the scientific sessions and as reflected in the living standards.”

The addition of the DAPA-CKD and FIDELIO-DKD trials show what is known about the connection between diabetes and end-stage renal disease.

“We now have more ways of controlling blood glucose and blood pressure,” and using therapy to prevent CKD, he said.

Gabbay mentioned the possibility of a new drug class the anticipation of results from the SURPASS trial, for a therapy that combines a glucagon-like peptide-1 receptor agonist (GLP-1) RA and a glucose-dependent insulinotropic polypeptide (GIP).

“That said, even in the presence of those treatments, there are a significant number of people that still develop chronic kidney disease. And diabetes continues to be the leading cause of end stage renal disease. And so, from the availability of new medications to drugs that are already out on the market, and the opportunity for a new class of drugs potentially, to come to market, I think are really quite exciting.”