HELP PREVENT CARDIORENAL RISK FROM TAKING HOLD OF YOUR T2D PATIENTS
Managing Type 2 diabetes (T2D) has mainly been focused on reducing HbA1c.
However, the heart and kidneys are adversely affected by T2D.1 Patients are at high risk of a decline in their renal function as well as high risk of early damage to their heart, which may lead to heart failure.2-7
This is why guidelines are evolving to consider management of the risk of heart failure and chronic kidney disease in patients with T2D.
For Healthcare Professionals
PATIENTS WITH T2D MAY BE AT RISK FOR CARDIORENAL COMPLICATIONS EARLY IN THEIR DISEASE
Type 2 diabetes (T2D) is associated with several micro- and macrovascular complications that start early, of which heart and kidney risks are prominent subtypes.4-9
Prediabetes is associated with an increased risk of cardiovascular (CV) disease and chronic kidney disease (CKD).4,8
*Compared with normoglycaemia.
68% of patients with T2D had evidence of left ventricular (LV) dysfunction within 5 years of T2D diagnosis.7*
In a real-world study,** heart failure (HF) and/or CKD was the most common early cardiovascular the complication in T2D patients – higher than stroke and myocardial infarction (MI).10
Adapted from Faden et al, 2013.
*Data from a prospective, multicentre study (N=386). Mean age was 71 years in LV dysfunction group and 64 in normal LV function group. Patients with LV dysfunction were older, had lower glomerular filtration rate, higher levels of glycated haemoglobin, C-reactive protein, LV mass, relative wall thickness and prevalence of valve calcifications.
Adapted from Birkeland et al, 2019.
**Real-world evidence taken from cohorts of patients from Germany, Japan, Norway and Sweden. PAD, peripheral artery disease.
CARDIOVASCULAR AND RENAL DISEASE ARE INTERLINKED IN PATIENTS WITH T2D
Declining renal function is associated with incident heart failure (HF), and HF is associated with significantly higher risk of incident chronic kidney disease (CKD).11-13
HF is a common cardiovascular (CV) complication in diabetic kidney disease, occurring more frequently than CV death.14,15
Elderly patients* with CKD are 6x more likely to die of heart disease than advance to end-stage renal disease (the rates per 100 person-years were 0.5 for end-stage renal disease and 3.0 for CV mortality).16*
*In a US longitudinal cohort study of 1268 patients over 65 years.
Adapted from Ng et al, 2017.
CARDIORENAL COMPLICATIONS ARE PREVALENT IN THE T2D PATIENT POPULATION
Heart failure (HF) is one of the first cardiovascular (CV) complications in patients with Type 2 diabetes (T2D), occurring before myocardial infarction and stroke.17
First presentation of CV events in T2D17*
Adapted from Shah et al, 2015.
NFMI, non-fatal myocardial infarction; PAD, peripheral artery disease.
*Retrospective cohort study of UK health records comparing first episode of CV events
between people with and without T2D, total n=6,137 and median follow-up of 5.5 years;
**HF post-MI was not included in this definition of HF.
In the T2D patient population:
EARLY RECOGNITION OF CARDIORENAL RISK IS IMPORTANT IN THE MANAGEMENT OF YOUR T2D PATIENTS
Early recognition of cardiorenal complications provides an opportunity for proactive management to help reduce the risk of heart failure (HF) or chronic kidney disease for your Type 2 diabetes (T2D) patients.19,20
AS CARDIORENAL DAMAGE CAN OCCUR IN T2D INDEPENDENT OF UNCONTROLLED HbA1c, COMPREHENSIVE PATIENT CARE IN T2D MERITS AN EARLY MANAGEMENT APPROACH TO ADDRESS THE CARDIORENAL RISKS.19,20
Differential 5-year survival rate for elderly diabetes patients with or without HF.21*
As the estimated glomerular filtration rate (eGFR) declines, the rates of cardiovascular (CV) events and hospitalisations increase:22
Adapted from Bertoni et al, 2004.
*In a study of patients aged 65 years or older.
Adapted from Go et al, 2004.
**Age-standardised rate (per 100 person-year). CV event was defined as hospitalisation for coronary heart disease, HF, ischaemic stroke, and peripheral arterial disease.
†Age-standardised rate (per 100 person-year). Based on data between 1996 and 2000 from the Kaiser Permanente Renal Registry (N=1,120,295) adults with no dialysis or renal transplantation; 52 years mean age; 55% women; 2.64 years median follow-up. eGFR, estimated glomerular filtration rate.
SYMPTOM RECOGNITION MAY HELP PROTECT AGAINST CARDIORENAL RISK
All of the major risk factors for heart failure (HF) and chronic kidney disease (CKD) may already be present in your patients with Type 2 diabetes (T2D).23-26
Heart failure: early signs and symptoms* of HF are non-specific and common, making it difficult to associate with HF:25-27
Chronic kidney disease: symptoms* of CKD usually get worse slowly and may not appear until the kidneys are badly damaged:24
*This is not a comprehensive list of symptoms.
TREATMENT GUIDELINES ARE EVOLVING TO CONSIDER HOLISTIC MANAGEMENT OF T2D
Recent updates in treatment guidelines recognise that Type 2 diabetes (T2D) management should have a holistic approach that addresses HbA1c alongside cardiorenal risk with diet, exercise, weight loss and treatment.19
EASD/ADA
GUIDELINES
The new EASD/ADA guidelines recognise the importance of managing the risk of heart and kidney damage in patients with T2D.19
ACC/AHA
GUIDELINES
The 2019 ACC/AHA guidelines for primary prevention of cardiovascular (CV) risk recommend a management approach that addresses CV risk factors in patients with T2D.20
THE MANAGEMENT OF CARDIORENAL RISK IS IMPORTANT FOR HOLISTIC T2D CARE
Consider beyond HbA1c in the management of Type 2 diabetes (T2D) to help address the risk of heart failure and kidney disease in your patients.