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Exp Clin Endocrinol Diabetes 2024; 132(02): 64-67
DOI: 10.1055/a-2166-6885
German Diabetes Association: Clinical Practice Guidelines

Diabetes Mellitus and the Heart

Katharina Schütt
1   Department of Internal Medicine I – Cardiology, Angiology and Internal Intensive Care Medicine, RWTH Aachen University Hospital, Aachen, Germany
,
Thomas Forst
2   CRS Clinical Research Services Mannheim GmbH, Mannheim, Germany
,
Andreas L. Birkenfeld
3   Department of Internal Medicine IV, University Hospital Tübingen, Germany
4   Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the University of Tübingen, German Center for Diabetes Research (DZD e. V.) Germany
,
Andreas Zirlik
5   Department of Internal Medicine – Division of Cardiology, LKH University Hospital Graz, Medical University Graz, Austria
,
Dirk Müller-Wieland
1   Department of Internal Medicine I – Cardiology, Angiology and Internal Intensive Care Medicine, RWTH Aachen University Hospital, Aachen, Germany
,
Nikolaus Marx
1   Department of Internal Medicine I – Cardiology, Angiology and Internal Intensive Care Medicine, RWTH Aachen University Hospital, Aachen, Germany
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Notice of update

The DDG clinical practice guidelines are updated regularly during the second half of the calendar year. Please ensure that you read and cite the respective current version.

UPDATES TO CONTENT COMPARED TO THE PREVIOUS YEAR’S VERSION

Change 1: Recently, another large cardiovascular outcome study, DELIVER, with the SGLT2 inhibitor dapagliflozin, showed that treatment with dapagliflozin significantly reduced the combined endpoint of hospitalization due to heart failure or CV death compared to placebo in patients with an ejection fraction greater than 40%. Predetermined subgroup analyses showed no significant difference between patients with and without DM.

Reason: Relevant new marketing authorisation for the treatment of heart failure with an ejection fraction>40%

Supporting reference: [20]

Change 2: Two studies (FIGARO-DKD and FIDELIO-DKD) investigated the effect of the new non-steroidal mineralocorticoid receptor antagonist finerenone in patients with diabetes, CKD and albuminuria. In both studies, finerenone reduced the risk of kidney failure and cardiovascular events compared to placebo. A prespecified analysis of both studies together (FIDELITY) showed in 13171 patients that finerenone, in combination with optimized RAS blockade, reduced the risk of the composite cardiovascular endpoint consisting of time to cardiovascular death, non-fatal myocardial infarction, non-fatal stroke or hospitalization due to heart failure by 14%. This effect was mainly due to a reduction in hospitalization due to heart failure, although patients with symptomatic heart failure with reduced pumping function were excluded from these studies. Whether finerenone can reduce heart failure outcomes in patients with HFpEF is currently being investigated in a large cardiovascular endpoint study (FINARTS-HF; NCT04435626).

Reason: New treatment options for patients with diabetes and CKD with a positive effect on hospitalization due to heart failure

Supporting reference: [21] [23]



Publikationsverlauf

Artikel online veröffentlicht:
23. Januar 2024

© 2024. Thieme. All rights reserved.

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  • References

  • 1 Anker SD, Butler J, Filippatos G. et al. Empagliflozin in Heart Failure with a Preserved Ejection Fraction. N Engl J Med 2021; 385: 1451-1461
    CrossrefPubMedSuche in Google Scholar
  • 2 Di Angelantonio E, Kaptoge S. Emerging Risk Factors C et al. Association of Cardiometabolic Multimorbidity With Mortality. JAMA 2015; 314: 52-60
    CrossrefPubMedSuche in Google Scholar
  • 3 Consentino FF, Grant PJ, Aboyans V. et al. 2019 ESC guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Eur Heart J 2020; 41: 255-323
    CrossrefPubMedSuche in Google Scholar
  • 4 Zinman B, Wanner C, Lachin JM. et al. Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes. N Engl J Med 2015; 373
    PubMedSuche in Google Scholar
  • 5 Neal B, Perkovic V, Mahaffey KW. et al. Canagliflozin and Cardiovascular and Renal Events in Type 2 Diabetes. N Engl J Med 2017; 377: 644-657
    CrossrefPubMedSuche in Google Scholar
  • 6 Wiviott SD, Raz I, Bonaca MP. et al. Dapagliflozin and Cardiovascular Outcomes in Type 2 Diabetes. N Engl J Med 2018; 380: 347-357
    CrossrefPubMedSuche in Google Scholar
  • 7 Marso SP, Daniels GH, Brown-Frandsen K. et al. Liraglutide and Cardiovascular Outcomes in Type 2 Diabetes. N Engl J Med 2016; 375: 311-322
    CrossrefPubMedSuche in Google Scholar
  • 8 Marso SP, Bain SC, Consoli A. et al. Semaglutide and Cardiovascular Outcomes in Patients with Type 2 Diabetes. N Engl J Med 2016; 375: 1834-1844
    CrossrefPubMedSuche in Google Scholar
  • 9 Hernandez AF, Green JB, Janmohamed S. et al. Albiglutide and cardiovascular outcomes in patients with type 2 diabetes and cardiovascular disease (Harmony Outcomes): a double-blind, randomised placebocontrolled trial. Lancet 2018; 392: 1519-1529
    CrossrefPubMedSuche in Google Scholar
  • 10 Gerstein HC, Colhoun HM, Dagenais GR. et al. Dulaglutide and cardiovascular outcomes in type 2 diabetes (REWIND): a double-blind, randomised placebo-controlled trial. Lancet 2019; 394: 121-130
    CrossrefPubMedSuche in Google Scholar
  • 11 Husain M, Birkenfeld AL, Donsmark M. et al. Oral Semaglutide and Cardiovascular Outcomes in Patients with Type 2 Diabetes. N Engl J Med 2019; 381: 841-851
    CrossrefPubMedSuche in Google Scholar
  • 12 Marso SP, Bain SC, Consoli A. et al. Semaglutide and Cardiovascular Outcomes in Patients with Type 2 Diabetes. N Engl J Med 2016; 375: 1834-1844
    CrossrefPubMedSuche in Google Scholar
  • 13 Nichols GA, Gullion CM, Koro CE. et al. The incidence of congestive heart failure in type 2 diabetes: an update. Diabetes Care 2004; 27: 1879-1884
    CrossrefPubMedSuche in Google Scholar
  • 14 MacDonald MR, Petrie MC, Varyani F. et al. Impact of diabetes on outcomes in patients with low and preserved ejection fraction heart failure: an analysis of the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM) programme. Eur Heart J 2008; 29: 1377-1385
    CrossrefPubMedSuche in Google Scholar
  • 15 McDonagh TA, Metra M, Adamo M. et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) With the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 2021; 42: 3599-3726
    CrossrefPubMedSuche in Google Scholar
  • 16 McMurray JJV, Solomon SD, Inzucchi SE. et al. Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction. N Engl J Med 2019; 381: 1995-2008
    CrossrefPubMedSuche in Google Scholar
  • 17 Packer M, Anker SD, Butler J. et al. Cardiovascular and Renal Outcomes with Empagliflozin in Heart Failure. N Engl J Med 2020; 383: 1413-1424
    CrossrefPubMedSuche in Google Scholar
  • 18 Zannad F, Ferreira JP, Pocock SJ. et al. SGLT2 inhibitors in patients with heart failure with reduced ejection fraction: a meta-analysis of the EMPEROR-Reduced and DAPA-HF trials. Lancet 2020; 396: 819-829
    CrossrefPubMedSuche in Google Scholar
  • 19 Kirchhof P, Benussi S, Kotecha D. et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS: The Task Force for the management of atrial fibrillation of the European Society of Cardiology (ESC)Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESCEndorsed by the European Stroke Organisation (ESO). Eur Heart J 2016; 37: 2893-2962
    CrossrefPubMedSuche in Google Scholar
  • 20 Solomon SD, McMurray JJV, Claggett BE. et al. Dapagliflozin in Heart Failure with Mildly Reduced or Preserved Ejection Fraction. N Engl J Med 2022; 387: 1089-1098
    CrossrefPubMedSuche in Google Scholar
  • 21 Pitt B, Filippatos GD, Agarwal R. et al. Cardiovascular Events with Finerenone in Kidney Disease and Type 2 Diabetes. N Engl J Med 2021; 385: 2252-2263
    CrossrefPubMedSuche in Google Scholar
  • 22 Bakris GL, Agarwal R, Anker SD. et al. Effect of Finerenone on Chronic Kidney Disease Outcomes in Type 2 Diabetes. N Engl J Med 2020; 383: 2219-2229
    CrossrefPubMedSuche in Google Scholar
  • 23 Agarwal R, Filippatos G, Pitt B. et al. Cardiovascular and kidney outcomes with finerenone in patients with type 2 diabetes and chronic kidney disease: the FIDELITY pooled analysis. Eur Heart J 2022; 43: 474-484
    CrossrefPubMedSuche in Google Scholar