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creased risk for symptomatic heart failure\n(216). In a combined analysis of three co-horts without disease (Atherosclerosis RiskIn Communities [ARIC], Dallas Heart Study,and Multi-Ethnic Study of Atherosclerosis\n[MESA]), including 33% of participants\nwith diabetes and 66% with prediabetes,biomarker screening strati ... | [
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high risk for incident heart failure (217). A\nsimilar association and prognostic values\nof increased NT-proBNP with increasedcardiovascular and all-cause mortality hasbeen reported in people with type 1 diabe-\ntes (218).\nResults from several randomized con-\ntrolled trials revealed that more inten- | [
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trolled trials revealed that more inten-\nsive treatment of risk factors in peoplewith increased levels of natriuretic pep-\ntides reduces the risk for symptomatic\nheart failure, heart failure hospitaliza-tion, and newly diagnosed left ventricu-lar dysfunction. The NT-proBNP GuidedPrimary Prevention of CV Events in Di... | [
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betic Patients (PONTIAC) trial enrolled\n300 people with type 2 diabetes and el-evated NT-proBNP levels to usual diabe-tes care versus usual diabetes care plus\nintensifi ed risk factor treatment in cardiac\noutpatient clinics (214). After 12 months,\nthere was signi ficant increased use of\nrenin-angiotensin system anta... | [
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renin-angiotensin system antagonists and\nb-blockers in the intensive treatment\ngroup but no difference in blood pres-\nsure. The primary outcome of hospitaliza-tion or death due to cardiac disease wassignificantly reduced in the intensive treat-\nment group (HR 0.35 [95% CI 0.13 –0.98]; P\n= 0.044). The St Vincent ’s ... | [
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= 0.044). The St Vincent ’s Screening to\nPrevent Heart Failure Study (STOP-HF)was a randomized controlled trial that\nenrolled 1,374 participants with cardio-\nvascular risk factors to receive eitherusual primary care or screening with BNPtesting. Participants with an elevated\nBNP level of 50 pg/mL or higher under- | [
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BNP level of 50 pg/mL or higher under-\nwent echocardiography followed by col-laborative care between primary carediabetesjournals.org/care Cardiovascular Disease and Risk Management S197\n©AmericanDiabetesAssociation | [
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Table 10.3 B—Cardiovascular and cardiorenal outcomes trials of available antihyperglycemic medications completed after the issuance of the FDA 2008 guidelines: GLP-1\nreceptor agonists\nELIXA (260)\n(n= 6,068)LEADER (255)\n(n= 9,340)SUSTAIN-6 (256)*\n(n= 3,297)EXSCEL (261)\n(n= 14,752)REWIND (259)\n(n= 9,901)PIONEER-6 ... | [
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(n= 14,752)REWIND (259)\n(n= 9,901)PIONEER-6 (257)\n(n= 3,183)\nIntervention Lixisenatide/placebo Liraglutide/placebo Semaglutide s.c.\ninjection/placeboExenatide QW/\nplaceboDulaglutide/placebo Semaglutide oral/placebo\nMain inclusion criteria Type 2 diabetes and\nhistory of ACS\n(<180 days)Type 2 diabetes and\npreexi... | [
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(<180 days)Type 2 diabetes and\npreexisting CVD,CKD, or HF at\n$50 years of age\nor CV risk at $60\nyears of ageType 2 diabetes and\npreexisting CVD,\nHF, or CKD at\n$50 years of age\nor CV risk at $60\nyears of ageType 2 diabetes\nwith or without\npreexisting CVDType 2 diabetes and\nprior ASCVDevent or risk\nfactors f... | [
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prior ASCVDevent or risk\nfactors for ASCVDType 2 diabetes and high\nCV risk (age of $50\nyears with establishedCVD or CKD, or age of$60 years with CV\nrisk factors only)\nA1C inclusion criteria (%) 5.5–11.0 $7.0 $7.0 6.5–10.0 #9.5 None\nAge (years) † 60.3 64.3 64.6 62 66.2 66\nRace (% White) 75.2 77.5 83.0 75.8 75.7 7... | [
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Race (% White) 75.2 77.5 83.0 75.8 75.7 72.3\nSex (% male) 69.3 64.3 60.7 62 53.7 68.4\nDiabetes duration (years) † 9.3 12.8 13.9 12 10.5 14.9\nMedian follow-up (years) 2.1 3.8 2.1 3.2 5.4 1.3\nStatin use (%) 93 72 73 74 66 85.2 (all lipid-lowering)\nMetformin use (%) 66 76 73 77 81 77.4\nPrior CVD/CHF (%) 100/22 81/18... | [
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Prior CVD/CHF (%) 100/22 81/18 60/24 73.1/16.2 32/9 84.7/12.2\nMean baseline A1C (%) 7.7 8.7 8.7 8.0 7.4 8.2\nMean difference in A1C\nbetween groups at end oftreatment (%)/C00.3‡^ /C00.4‡ /C00.7 or /C01.0^ /C00.53‡^ /C00.61‡ /C00.7\nYear started/reported 2010/2015 2010/2016 2013/2016 2010/2017 2011/2019 2017/2019\nPrim... | [
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Primary outcome § 4-point MACE\n1.02 (0.89 –1.17)3-point MACE\n0.87 (0.78 –0.97)3-point MACE\n0.74 (0.58 –0.95)3-point MACE\n0.91 (0.83 –1.00)3-point MACE\n0.88 (0.79 –0.99)3-point MACE\n0.79 (0.57 –1.11)\nContinued on p. S199S198 Cardiovascular Disease and Risk Management Diabetes Care Volume 47, Supplement 1, January... | [
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physicians and cardiovascular specialist\nservices. Participants in the interventiongroup received more renin-angiotensin/aldosterone system –based therapy. The\nprimary end point of left ventricular dys-\nfunction and heart failure was signi fi-\nc a n t l yr e d u c e di nt h ei n t e r v e n t i o ng r o u p\n(odds r... | [
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(odds ratio 0.55 [95% CI 0.37 –0.82];\nP= 0.003). The risk for left ventricular sys-\ntolic dysfunction, diastolic dysfunction, orheart failure was signi ficantly reduced in\nthe BNP-guided intervention group. Ap-proximately 18% of people in the control\na n di n t e r v e n t i o ng r o u p sh a dad i a g n o s i s | [
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a n di n t e r v e n t i o ng r o u p sh a dad i a g n o s i s\nof diabetes. Finally, in the original Intensi-fied Multifactorial Intervention in Pa-\ntients With Type 2 Diabetes andMicroalbuminuria (Steno-2) trial, 160 in-\ndividuals with type 2 diabetes and mi- | [
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dividuals with type 2 diabetes and mi-\ncroalbuminuria were enrolled, and thetrial examined the effect of multifacto-rial treatment on cardiovascular out-\ncomes (219). When strati fied in a later\nanalysis by NT-proBNP levels, plasma\nNT-proBNP levels above the medianwere associated with increased risk of\ncardiovascul... | [
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cardiovascular disease, and a decrease in\nplasma NT-proBNP of 10 pg/mL for thefirst 2 years of intervention was associated\nwith a 1% relative risk reduction in theprimary cardiovascular end point (220).\nBased on this collective evidence, the | [
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Based on this collective evidence, the\ncommittee recommends considering screen-ing asymptomatic adults with diabetes forthe development of cardiac structural orfunctional abnormalities (stage B heart\nfailure) by measurement of natriuretic | [
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failure) by measurement of natriuretic\npeptides, including BNP or NT-proBNPlevels. The biomarker threshold for ab-normal values is a BNP level $50 pg/mL\nand NT-proBNP $125 pg/mL. Abnormal\nlevels of natriuretic peptide will need tobe evaluated in the context of each indi-vidual, using clinical judgment, and in the | [
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absence of any possible competing diag-\nnoses, particularly recognizing conditionsthat may lead to increased levels ofnatriuretic peptide, including renal in-sufficiency, pulmonary disease including | [
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pulmonary hypertension and chronic ob-structive lung disease, obstructive sleepapnea, ischemic and hemorrhagic stroke,and anemia. Conversely, natriuretic pep-\ntide levels may be decreased in the\npopulation with obesity, which impairssensitivity of testing.\nRisk strati fication for incident heart fail- | [
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Risk strati fication for incident heart fail-\nu r e( s t a g eA )a n di d e n t i fication of people\nwith asymptomatic cardiac abnormalities(stage B) may prevent progression toTable 10.3 B—Continued\nELIXA (260)\n(n= 6,068)LEADER (255)\n(n= 9,340)SUSTAIN-6 (256)*\n(n= 3,297)EXSCEL (261)\n(n= 14,752)REWIND (259)\n(n= 9,... | [
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(n= 14,752)REWIND (259)\n(n= 9,901)PIONEER-6 (257)\n(n= 3,183)\nKey secondary outcome § Expanded MACE\n1.02 (0.90 –1.11)Expanded MACE\n0.88 (0.81 –0.96)Expanded MACE\n0.74 (0.62 –0.89)Individual\ncomponents of\nMACE (see\nbelow)Composite\nmicrovascular\noutcome (eye or\nrenal outcome)0.87 (0.79 –0.95)Expanded MACE or H... | [
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hospitalization\n0.82 (0.61 –1.10)\nCardiovascular death § 0.98 (0.78 –1.22) 0.78 (0.66 –0.93) 0.98 (0.65 –1.48) 0.88 (0.76 –1.02) 0.91 (0.78 –1.06) 0.49 (0.27 –0.92)\nMI§ 1.03 (0.87 –1.22) 0.86 (0.73 –1.00) 0.74 (0.51 –1.08) 0.97 (0.85 –1.10) 0.96 (0.79 –1.15) 1.18 (0.73 –1.90) | [
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0.03848962485790253,
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Stroke § 1.12 (0.79 –1.58) 0.86 (0.71 –1.06) 0.61 (0.38 –0.99) 0.85 (0.70 –1.03) 0.76 (0.61 –0.95) 0.74 (0.35 –1.57)\nHF hospitalization § 0.96 (0.75 –1.23) 0.87 (0.73 –1.05) 1.11 (0.77 –1.61) 0.94 (0.78 –1.13) 0.93 (0.77 –1.12) 0.86 (0.48 –1.55)\nUnstable angina | [
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Unstable angina\nhospitalization §1.11 (0.47 –2.62) 0.98 (0.76 –1.26) 0.82 (0.47 –1.44) 1.05 (0.94 –1.18) 1.14 (0.84 –1.54) 1.56 (0.60 –4.01)\nAll-cause mortality § 0.94 (0.78 –1.13) 0.85 (0.74 –0.97) 1.05 (0.74 –1.50) 0.86 (0.77 –0.97) 0.90 (0.80 –1.01) 0.51 (0.31 –0.84) | [
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Worsening nephropathy §jj — 0.78 (0.67 –0.92) 0.64 (0.46 –0.88) — 0.85 (0.77 –0.93) —\n—, not assessed/reported; ACS, acute coronary syndrome; ASCVD, atherosclerotic cardiovascular disease; CHF, congestive heart failure; CKD, chron ic kidney disease; CV, cardiovascular; CVD, cardiovascular disease; | [
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0.03245660290122032,
-0.000... |
GLP-1, glucagon-like peptide 1; HF, heart failure; MACE, major adverse cardiovascular event; MI, myocardial infarction. Data in this table were adapted from Cefalu et al. (313). *Powered to rule out a hazard ra- | [
-0.0014373755548149347,
-0.03829628601670265,
-0.07369881868362427,
0.02954055182635784,
0.027958132326602936,
-0.0006581059424206614,
-0.011621665209531784,
0.12818868458271027,
0.01886831596493721,
-0.0024221171624958515,
0.04585699737071991,
-0.018546506762504578,
-0.0896202027797699,
0... |
tio of 1.8; superiority hypothesis not prespeci fied.†Age was reported as means in all trials; diabetes duration was reported as means in all trials except EXSCEL, which reported medians. ‡Signi ficant | [
0.05034153163433075,
0.0477951243519783,
-0.044514890760183334,
0.04034995660185814,
-0.03902439400553703,
0.02392781339585781,
-0.000321444240398705,
0.12406289577484131,
-0.05220412835478783,
0.04400066286325455,
0.02758135460317135,
0.032564032822847366,
-0.0036652307026088238,
0.001828... |
difference in A1C between groups ( P<0.05). ^A1C change of 0.66% with 0.5 mg and 1.05% with 1-mg dose of semaglutide. §Outcomes reported as hazard ratio (95% Cl). jjWorsening nephropathy is | [
0.05414814129471779,
-0.05131123587489128,
0.008734815753996372,
0.008228630758821964,
-0.027999423444271088,
-0.03865731135010719,
-0.014829199761152267,
0.1886778473854065,
0.06310886889696121,
-0.032073792070150375,
-0.041810061782598495,
-0.0071729496121406555,
0.0398690365254879,
0.01... |
defined as the new onset of urine albumin-to-creatinine ratio >300 mg/g creatinine or a doubling of the serum creatinine level and an estimated glomerular filtration rate of <45 mL/min/1.73 m\n2, the | [
-0.018986428156495094,
-0.03689207136631012,
-0.004116881638765335,
-0.011854809708893299,
-0.049457769840955734,
-0.04510559141635895,
-0.0030290973372757435,
0.13868725299835205,
-0.018256209790706635,
-0.05777648463845253,
0.014761844649910927,
-0.060452479869127274,
-0.01279754750430584,... |
2, the\nneed for continuous renal replacement therapy, or death from renal disease in LEADER and SUSTAIN-6 and as new macroalbuminuria, a sustained decline in estimated glomerular filtration rate of 30% | [
-0.0025002851616591215,
-0.03168041259050369,
0.023361951112747192,
-0.035552993416786194,
-0.025996698066592216,
-0.003915545996278524,
-0.05065296217799187,
0.1320057064294815,
-0.010723520070314407,
-0.02930777706205845,
-0.024803433567285538,
0.037560414522886276,
0.03302319720387459,
... |
or more from baseline, or chronic renal replacement therapy in REWIND. Worsening nephropathy was a prespeci fied exploratory adjudicated outcome in LEADER, SUSTAIN-6, and REWIND.diabetesjournals.org/care Cardiovascular Disease and Risk Management S199\n©AmericanDiabetesAssociation | [
-0.00501372991129756,
0.010408066213130951,
0.047038786113262177,
0.0582728236913681,
-0.08500673621892929,
0.02329535037279129,
-0.05414827540516853,
0.045421943068504333,
-0.014040321111679077,
-0.07232318818569183,
-0.06497271358966827,
0.14041920006275177,
-0.002896212274208665,
0.0058... |
Table 10.3 C—Cardiovascular and cardiorenal outcomes trials of available antihyperglycemic medications completed after the issuance of the FDA 2008 guidelines: SGLT2\ninhibitors\nEMPA-REG\nOUTCOME (11)\n(n= 7,020)CANVAS\nProgram (12)\n(n= 10,142)DECLARE-TIMI 58\n(249)\n(n= 17,160)CREDENCE (247)\n(n= 4,401)DAPA-CKD (250... | [
-0.04354352876543999,
-0.01727028749883175,
-0.018650775775313377,
0.006156492978334427,
-0.021698998287320137,
-0.008741798810660839,
-0.050905968993902206,
0.16385959088802338,
-0.020525671541690826,
0.006192643195390701,
-0.025883754715323448,
-0.013545338995754719,
-0.046004388481378555,... |
(n= 4,401)DAPA-CKD (250,314)\n(n= 4,304; 2,906\nwith diabetes)VERTIS CV (254,315)\n(n= 8,246)DAPA-HF (14)\n(n= 4,744; 1,983\nwith diabetes)EMPEROR-Reduced\n(253)\n(n= 3,730; 1,856\nwith diabetes)EMPEROR-Preserved\n(242,316)\n(n= 5,988; 2,938 with\ndiabetes)DELIVER (252)\n(n= 6,263; 2,807\nwith diabetes) | [
-0.05626419931650162,
0.030866507440805435,
-0.0709013119339943,
0.02583053521811962,
-0.04712976515293121,
0.009984920732676983,
-0.016704756766557693,
0.11660120636224747,
-0.05874127149581909,
-0.044046834111213684,
0.009276998229324818,
-0.023064643144607544,
-0.05362032726407051,
-0.0... |
diabetes)DELIVER (252)\n(n= 6,263; 2,807\nwith diabetes)\nIntervention Empagli flozin/placebo Canagli flozin/placebo Dapaglifl ozin/placebo Canagli flozin/placebo Dapaglifl ozin/placebo Ertuglifl ozin/placebo Dapagli flozin/placebo Empagli flozin/placebo* Empaglifl ozin/placebo Dapagli flozin/placebo\nMain inclusion criteria Typ... | [
0.014202604070305824,
-0.014060763642191887,
-0.06916210055351257,
0.045212868601083755,
-0.09835599362850189,
-0.015665410086512566,
0.0754508525133133,
0.09569109231233597,
-0.010464971885085106,
-0.053502157330513,
0.0027981086168438196,
-0.013147188350558281,
-0.015917131677269936,
-0.... |
Main inclusion criteria Type 2 diabetes and\npreexisting CVDType 2 diabetes and\npreexisting CVD at\n$30 years of age\nor$2 CV risk\nfactors at $50\nyears of ageType 2 diabetes and\nestablished ASCVDor multiple riskfactors for ASCVDType 2 diabetes and\nalbuminurickidney diseaseAlbuminuric kidney\ndisease, with orwithou... | [
-0.024564174935221672,
0.021770844236016273,
-0.025325609371066093,
0.011919953860342503,
-0.009019439108669758,
0.06627752631902695,
-0.029937593266367912,
0.0692332312464714,
-0.0901484563946724,
-0.04258383810520172,
0.009583334438502789,
-0.04921497404575348,
-0.025003520771861076,
-0.... |
disease, with orwithout diabetesType 2 diabetes and\nASCVDNYHA class II, III, or\nIV heart failureand an ejectionfraction #40%,\nwith or withoutdiabetesNYHA class II, III, or\nIV heart failureand an ejectionfraction #40%,\nwith or withoutdiabetesNYHA class II, III, or IV\nheart failure and anejection fraction>40%NYHA c... | [
0.03459322825074196,
0.039804838597774506,
-0.030592652037739754,
0.012086537666618824,
-0.06295064091682434,
0.009329080581665039,
0.01768042892217636,
0.06533754616975784,
-0.044067658483982086,
0.00845484621822834,
0.038065578788518906,
0.006429136730730534,
-0.04732803627848625,
0.0440... |
heart failure and anejection fraction>40%NYHA class II, III, or\nIV heart failureand an ejectionfraction >40%\nwith or withoutdiabetes\nA1C inclusion criteria\n(%)7.0–10.0 7.0–10.5 $6.5 6.5–12 — 7.0–10.5 ——— —\nAge (years) † 63.1 63.3 64.0 63 61.8 64.4 66 67.2, 66.5 71.8, 71.9 71.7 | [
0.04042300581932068,
0.04697972536087036,
0.00009149184916168451,
0.03294750675559044,
-0.030675232410430908,
0.004921421408653259,
-0.0031085775699466467,
0.06137611344456673,
-0.04891246184706688,
-0.021093349903821945,
0.015139568597078323,
-0.022029438987374306,
-0.04319297894835472,
0... |
Race (% White) 72.4 78.3 79.6 66.6 53.2 87.8 70.3 71.1, 69.8 76.3, 75.4 71.2\nSex (% male) 71.5 64.2 62.6 66.1 66.9 70 76.6 76.5, 75.6 55.4, 55.3 56.1\nDiabetes duration\n(years) †57%>10 13.5 11.0 15.8 — 12.9 ——— —\nMedian follow-up\n(years)3.1 3.6 4.2 2.6 2.4 3.5 1.5 1.3 2.2 2.3\nStatin use (%) 77 75 75 (statin or\nez... | [
0.012477260082960129,
0.05252324044704437,
-0.08747740089893341,
0.06487738341093063,
-0.03823309391736984,
0.038659557700157166,
-0.021296214312314987,
0.04993203282356262,
-0.0567336268723011,
-0.06017250567674637,
-0.0668184831738472,
-0.04072410985827446,
-0.07246159017086029,
-0.03429... |
ezetimibe use)69 64.9 ———68.1, 68.8 —\nMetformin use (%) 74 77 82 57.8 29 — 51.2% (of people\nwith diabetes)—— —\nPrior CVD/CHF (%) 99/10 65.6/14.4 40/10 50.4/14.8 37.4/10.9 99.9/23.1 100% with CHF 100% with CHF 100% with CHF 100% with CHF\nMean baseline\nA1C (%)8.1 8.2 8.3 8.3 7.1% (7.8% in those\nwith diabetes)8.2 ——... | [
0.03957964479923248,
0.0333142913877964,
-0.10845176130533218,
0.04423477128148079,
0.0005816938355565071,
0.020031657069921494,
0.010604318231344223,
0.1547299325466156,
-0.027474889531731606,
-0.022576168179512024,
-0.03460778295993805,
-0.013448157347738743,
-0.035448409616947174,
-0.04... |
with diabetes)8.2 ——— 6.6\nMean difference in\nA1C betweengroups at end of\ntreatment (%)/C00.3^ /C00.58 ‡ /C00.43 ‡ /C00.31 — /C00.48 to /C00.5 ——— —\nYear started/reported 2010/2015 2009/2017 2013/2018 2017/2019 2017/2020 2013/2020 2017/2019 2017/2020 2017/2020 2018/2022 | [
-0.0210640337318182,
-0.023199496790766716,
-0.053012292832136154,
0.09153008460998535,
0.005946111865341663,
-0.018395526334643364,
-0.002161898883059621,
0.14531585574150085,
0.04235750809311867,
-0.0387820266187191,
-0.0013342832680791616,
-0.00748480623587966,
-0.055062856525182724,
0.... |
Continued on p. S201S200 Cardiovascular Disease and Risk Management Diabetes Care Volume 47, Supplement 1, January 2024\n©AmericanDiabetesAssociation | [
-0.04130231589078903,
-0.03239266201853752,
-0.042942360043525696,
0.0571679063141346,
0.018323546275496483,
0.0236519668251276,
-0.042661696672439575,
0.050483282655477524,
-0.053598515689373016,
-0.055838167667388916,
-0.026676161214709282,
0.07037889957427979,
-0.00719023309648037,
-0.0... |
Table 10.3 C—Continued\nEMPA-REG\nOUTCOME (11)\n(n= 7,020)CANVAS\nProgram (12)\n(n= 10,142)DECLARE-TIMI 58\n(249)\n(n= 17,160)CREDENCE (247)\n(n= 4,401)DAPA-CKD (250,314)\n(n= 4,304; 2,906\nwith diabetes)VERTIS CV (254,315)\n(n= 8,246)DAPA-HF (14)\n(n= 4,744; 1,983\nwith diabetes)EMPEROR-Reduced\n(253)\n(n= 3,730; 1,85... | [
-0.07514770328998566,
0.044525209814310074,
-0.04485391825437546,
-0.008750149980187416,
-0.046742167323827744,
0.06545533984899521,
-0.007402158807963133,
0.12759427726268768,
-0.08084613084793091,
-0.0024360534735023975,
0.026113364845514297,
-0.04895051568746567,
-0.07026223093271255,
-... |
(253)\n(n= 3,730; 1,856\nwith diabetes)EMPEROR-Preserved\n(242,316)\n(n= 5,988; 2,938 with\ndiabetes)DELIVER (252)\n(n= 6,263; 2,807\nwith diabetes)\nPrimary outcome§ 3-point MACE\n0.86 (0.74 –0.99)3-point MACE\n0.86 (0.75 –0.97)3-point MACE\n0.93 (0.84 –1.03)\nCV death or HF\nhospitalization\n0.83 (0.73 –0.95)ESRD, do... | [
-0.002365279709920287,
-0.03376172482967377,
-0.03779427707195282,
0.048430390655994415,
-0.027256645262241364,
0.009942206554114819,
0.022009246051311493,
0.15733219683170319,
-0.014209733344614506,
-0.023490238934755325,
0.01160308439284563,
0.05042288079857826,
-0.03829414024949074,
0.0... |
0.83 (0.73 –0.95)ESRD, doubling of\ncreatinine, ordeath from renal\nor CV cause\n0.70 (0.59 –0.82)$50% decline in\neGFR, ESKD, ordeath from renal\nor CV cause\n0.61 (0.51 –0.72)3-point MACE\n0.97 (0.85 –1.11)Worsening heart\nfailure or deathfrom CV causes\n0.74 (0.65 –0.85)\nResults did not differ\nby diabetes statusCV... | [
-0.0030592966359108686,
0.0008455220377072692,
-0.011160288006067276,
-0.023464862257242203,
0.05256583169102669,
-0.030336840078234673,
-0.05009687319397926,
0.13490544259548187,
0.005150239448994398,
0.006752538960427046,
-0.004955608397722244,
0.0023062624968588352,
0.007163355126976967,
... |
by diabetes statusCV death or HF\nhospitalization\n0.75 (0.65 –0.86)CV death or HF\nhospitalization0.79 (0.69 –0.90)Worsening HF or CV\ndeath0.82 (0.73 –0.92)\nKey secondary\noutcome §4-point MACE\n0.89 (0.78 –1.01)All-cause and CV\nmortality (see\nbelow)Death from any\ncause 0.93(0.82 –1.04)\nRenal composite\n($40% de... | [
0.03738701343536377,
0.008154792711138725,
-0.06003236770629883,
0.01014844048768282,
0.060203343629837036,
-0.017186027020215988,
-0.009993694722652435,
0.1444871872663498,
-0.026575418189167976,
0.011799807660281658,
-0.01685045287013054,
-0.006638181395828724,
-0.010104074142873287,
0.0... |
Renal composite\n($40% decrease\nin eGFR rate to\n<60 mL/min/1.73 m\n2, new\nESRD, or death\nfrom renal or CV\ncauses0.76 (0.67 –0.87)CV death or HF\nhospitalization\n0.69 (0.57 –0.83)\n3-point MACE 0.80\n(0.67 –0.95)$50% decline in\neGFR, ESKD, ordeath from\nrenal cause0.56 (0.45 –0.68)\nCV death or HF\nhospitalizatio... | [
0.026719048619270325,
-0.017326761037111282,
0.012630392797291279,
-0.03816477954387665,
0.02299935556948185,
-0.042377643287181854,
-0.038229212164878845,
0.18307200074195862,
-0.005566328763961792,
0.014977575279772282,
0.028054174035787582,
-0.013989628292620182,
0.030731264501810074,
0... |
CV death or HF\nhospitalization0.71 (0.55 –0.92)\nDeath from\nany cause0.69 (0.53 –0.88)CV death or HF\nhospitalization\n0.88 (0.75 –1.03)\nCV death\n0.92 (0.77 –1.11)\nRenal death, renal\nreplacement\ntherapy, ordoubling of\ncreatinine\n0.81 (0.63 –1.04)CV death or HF\nhospitalization\n0.75 (0.65 –0.85)Total HF\nhospi... | [
0.005067493300884962,
0.014031401835381985,
-0.04629053547978401,
-0.06982581317424774,
0.032469868659973145,
-0.019480306655168533,
-0.08099145442247391,
0.15110132098197937,
-0.01215147040784359,
0.022635996341705322,
0.05770072340965271,
-0.06619946658611298,
0.023300306871533394,
0.011... |
hospitalizations0.70 (0.58 –0.85)\nMean slope of\nchange in eGFR1.73 (1.10 –2.37)All HF hospitalizations\n(first and recurrent)\n0.73 (0.61 –0.88)\nRate of decline in eGFR\n(/C01.25 vs. /C02.62\nmL/min/1.73 m\n2;\nP<0.001)Total number\nworsening HFand CV deaths\n0.77 (0.67 –0.89)\nChange in KCCQ TSS\nat month 8 1.11(1.0... | [
0.02005821093916893,
0.024654414504766464,
0.018556779250502586,
-0.006257561966776848,
0.02050643227994442,
0.0023031041491776705,
-0.07816486060619354,
0.1447223424911499,
-0.008017790503799915,
0.03897760063409805,
0.05366209149360657,
-0.042269837111234665,
-0.007398063782602549,
-0.02... |
at month 8 1.11(1.03 –1.21)\nMean change in\nKCCQ TSS\n2.4 (1.5– 3.4)\nAll-cause mortality\n0.94 (0.83 –1.07)\nCardiovascular death §0.62 (0.49 –0.77) 0.87 (0.72 –1.06) 0.98 (0.82 –1.17) 0.78 (0.61 –1.00) 0.81 (0.58 –1.12) 0.92 (0.77 –1.11) 0.82 (0.69 –0.98) 0.92 (0.75 –1.12) 0.91 (0.76 –1.09) 0.88 (0.74 –1.05) | [
0.020807864144444466,
-0.012526794336736202,
-0.006298166234046221,
0.02710293047130108,
-0.045178741216659546,
-0.025493519380688667,
-0.04643640294671059,
0.09022117406129837,
0.009437342174351215,
0.0657215416431427,
0.061649810522794724,
-0.03680437058210373,
-0.01093248464167118,
-0.0... |
MI§ 0.87 (0.70 –1.09) 0.89 (0.73 –1.09) 0.89 (0.77 –1.01) ——1.04 (0.86 –1.26) ——— —\nStroke § 1.18 (0.89 –1.56) 0.87 (0.69 –1.09) 1.01 (0.84 –1.21) ——1.06 (0.82 –1.37) ——— — | [
0.00612338911741972,
-0.058846741914749146,
0.04734516888856888,
0.028086259961128235,
-0.023752382025122643,
-0.003956809174269438,
0.021305827423930168,
0.049948398023843765,
0.007629637606441975,
-0.02406405285000801,
0.06863706558942795,
0.02921086549758911,
0.023072831332683563,
0.016... |
HF hospitalization § 0.65 (0.50 –0.85) 0.67 (0.52 –0.87) 0.73 (0.61 –0.88) 0.61 (0.47 –0.80) — 0.70 (0.54 –0.90) 0.70 (0.59 –0.83) 0.69 (0.59 –0.81) 0.73 (0.61 –0.88) 0.77 (0.67 –0.89)\nUnstable angina\nhospitalization §0.99 (0.74 –1.34) —— —————— — | [
0.11290642619132996,
-0.00017170162755064666,
-0.06053074821829796,
-0.020173940807580948,
-0.0076043265871703625,
-0.033352673053741455,
-0.052149225026369095,
0.07654333859682083,
0.00043203047243878245,
-0.025473305955529213,
0.013970059342682362,
0.007825097069144249,
-0.0509397089481353... |
Unstable angina\nhospitalization §0.99 (0.74 –1.34) —— —————— —\nAll-cause mortality § 0.68 (0.57 –0.82) 0.87 (0.74 –1.01) 0.93 (0.82 –1.04) 0.83 (0.68 –1.02) 0.69 (0.53 –0.88) 0.93 (0.80 –1.08) 0.83 (0.71 –0.97) 0.92 (0.77 –1.10) 1.00 (0.87 –1.15) 0.94 (0.83 –1.07)\nWorsening | [
0.07737535238265991,
-0.0026581131387501955,
-0.012976903468370438,
0.02518489956855774,
-0.021277986466884613,
-0.03170762583613396,
-0.07331667840480804,
0.08647118508815765,
-0.004247534554451704,
-0.03509775549173355,
-0.0011556396493688226,
0.01615079678595066,
-0.029006248340010643,
... |
Worsening\nnephropathy §jj0.61 (0.53 –0.70) 0.60 (0.47 –0.77) 0.53 (0.43 –0.66) (See primary\noutcome)(See primary\noutcome)(See secondary\noutcomes)0.71 (0.44 –1.16) Composite renal\noutcome 0.50\n(0.32 –0.77)Composite renal\noutcome**0.95 (0.73 –1.24)— | [
0.02286354824900627,
-0.0180435162037611,
0.08963080495595932,
0.01223473809659481,
-0.06952771544456482,
-0.09806700050830841,
-0.0365363247692585,
0.15789926052093506,
0.002315413672477007,
-0.06338409334421158,
-0.05987207964062691,
0.04993303865194321,
0.07207177579402924,
0.0304569490... |
outcome 0.50\n(0.32 –0.77)Composite renal\noutcome**0.95 (0.73 –1.24)—\n—, not assessed/reported; CHF, congestive heart failure; CV, cardiovascular; CVD, cardiovascular disease; eGFR, estimated glomerular filtration rate; ESRD, end-stage renal disease; HF, heart failure; | [
0.016747351735830307,
0.02976260334253311,
0.007303065154701471,
-0.0604291670024395,
-0.02274048700928688,
-0.05835631117224693,
-0.056654635816812515,
0.12858007848262787,
-0.03285285830497742,
-0.027969125658273697,
0.006192369386553764,
-0.04890056699514389,
0.008927106857299805,
0.023... |
KCCQ TSS, Kansas City Cardiomyopathy Questionnaire Total Symptom Score; MACE, major adverse cardiovascular event; MI, myocardial infarction; SGLT2, sodium–glucose cotransporter 2; NYHA, New | [
0.03447422385215759,
-0.018822601065039635,
0.006155265495181084,
0.11425773054361343,
0.019051017239689827,
0.030863039195537567,
-0.022608699277043343,
0.0637645348906517,
-0.035131435841321945,
0.009795529767870903,
-0.02501712739467621,
-0.07315460592508316,
-0.03429378196597099,
0.030... |
York Heart Association. Data in this table were adapted from Cefalu et al. (313). *Baseline characteristics for EMPEROR-Reduced displayed as empagli flozin, placebo. †Age was reported as means in all | [
0.09205136448144913,
0.02235894277691841,
0.0197600144892931,
0.04707813262939453,
-0.036888908594846725,
0.022245168685913086,
-0.08513380587100983,
0.06991202384233475,
-0.04694776237010956,
-0.05759130418300629,
0.05462787672877312,
-0.04149336367845535,
-0.052478257566690445,
-0.003991... |
trials; diabetes duration was reported as means in all trials except EMPA-REG OUTCOME, which reported as percentage of population with diabetes duration >10 years, and DECLARE-TIMI 58, which re- | [
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0.0837857723236084,
0.00493781641125679,
0.06664535403251648,
-0.023436324670910835,
0.01708284579217434,
-0.024359004572033882,
0.09530336409807205,
-0.015701839700341225,
0.010498791933059692,
0.02219504863023758,
0.018591290339827538,
-0.0143052339553833,
-0.03148... |
ported median. ‡Signi ficant difference in A1C between groups ( P<0.05). ^AIC change of 0.30 in EMPA-REG OUTCOME is based on pooled results for both doses (i.e., 0.24% for 10 mg and 0.36% for | [
0.033255066722631454,
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0.005255429074168205,
-0.017693309113383293,
0.01448014471679926,
-0.08672262728214264,
-0.0233536995947361,
0.19180694222450256,
0.0072015938349068165,
0.01984747312963009,
0.06008119136095047,
-0.006163002923130989,
-0.0025177570059895515,
0.04... |
25 mg of empagli flozin). §Outcomes reported as hazard ratio (95% CI). jjDefinitions of worsening nephropathy differed between trials. **Composite outcome in EMPEROR-Preserved: time to first occur- | [
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0.02012680657207966,
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0.015148144215345383,
-0.03200608864426613,
-0.07550846040248871,
-0.03340722247958183,
0.21445903182029724,
0.01722903735935688,
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0.017603076994419098,
-0.020161014050245285,
0.041728727519512177,
0.0283261... |
rence of chronic dialysis, renal transplantation; sustained reduction of $40% in eGFR, sustained eGFR <15 mL/min/1.73 m2for individuals with baseline eGFR $30 mL/min/1.73 m2.diabetesjournals.org/care Cardiovascular Disease and Risk Management S201\n©AmericanDiabetesAssociation | [
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0.015633651986718178,
0.005271983798593283,
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0.024033352732658386,
0.0698866918683052,
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-0.... |
the symptomatic stages of heart failure\n(stages C and D). People with diabetes\nand an elevated natriuretic peptide levelwithout any symptoms of heart failure\nshould be considered to have stage B\nheart failure, as there is evidence for in-creased filling pressure and wall strain. In | [
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0.003008938394486904,
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0.008116589859127998,
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0.017152512446045876,
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0.057325053960084915,
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-0.03965591639280319,
-0.04228511080145836,
-0.07099039107561111,
-0.04021386429667473,
... |
people with diabetes and an abnormalnatriuretic peptide level, echocardiogra-phy is recommended as the next step toscreen for structural heart disease and\nechocardiographic Doppler indices for evi-\ndence of diastolic dysfunction and in-creased filling pressures (221). At this | [
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0.06621889024972916,
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0.03212603181600571,
-0.08853743225336075,
0.050... |
stage, an interprofessional approach,which should include a cardiovasculardisease specialist, is recommended toimplement a guideline-directed medical\ntreatment strategy, which may reduce\nthe risk of progression to symptomaticstages of heart failure (213). The recom-\nmendations for screening and treatment | [
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0.08054842054843903,
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0.02341... |
mendations for screening and treatment\nof heart failure in people with diabetesdiscussed in this section are consistent\nwith the ADA consensus report on heart\nfailure (7) and with current AmericanHeart Association/American College ofCardiology/Heart Failure Society of Amer-\nica guidelines for the management of\nhea... | [
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0.010908221825957298,
0.008615617640316486,
0.018864048644900322,
0.046629808843135834,
0.02652709372341633,
-0.06836634874343872,
-0.07151078432798386,
-0.05631551891565323,
0.04177110642194748,
-0.06337942183017731,
0.030153... |
ica guidelines for the management of\nheart failure (210).\nScreening for Asymptomatic\nPeripheral Artery Disease in People\nWith Diabetes\nThe risk for PAD in people with diabetes\nis higher than that in people withoutdiabetes (222 –224). In the PAD Aware- | [
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ness, Risk, and Treatment: New Resour-ces for Survival (PARTNERS) program,30% of people aged 50 –69 years with a\nhistory of cigarette smoking or diabetes,\nor aged $70 years regardless of risk fac-\ntors, had PAD (225). Similarly, in other\nscreening studies, 26% of people with di-\nabetes have been shown to have PAD | [
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0.03853060305118561,
0.06035904213786125,
0.009154312312602997,
-0.04004846513271332,
0.00605... |
abetes have been shown to have PAD\n(226), and diabetes increased the odds ofhaving PAD by 85% (227). Notably, classi-\ncal symptoms of claudication are uncom-\nmon, and almost half of people withnewly diagnosed PAD were asymptom-atic (225). Conversely, up to two-thirds\nof people with asymptomatic PAD have | [
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0.04537425562739372,
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0.0... |
of people with asymptomatic PAD have\nbeen shown to have comorbid diabetes(228). Risk factors associated with an in-\ncreased risk for PAD in people with diabe-\ntes include age, smoking, hypertension,dyslipidemia, worse glycemic control,longer duration of diabetes, neuropathy,\nand retinopathy as well as a prior histo... | [
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0.021912837401032448,
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0.09572022408246994,
0.09040351212024689,
0.018165823072195053,
-0.006019673775881529,
0.06947518140077591,
0.0370546355843544,
-0.018810922279953957,
0.0087... |
and retinopathy as well as a prior history\nof cardiovascular disease (229,230). Inaddition, the presence of microvascular\ndisease is associated with adverse out-comes in people with PAD, including anincreased risk for future limb amputa-tion (231,232).\nScreening for asymptomatic PAD may | [
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0.0592566... |
Screening for asymptomatic PAD may\nlead to early detection and treatment strat-egies to reduce the risk for progression of\nPAD and limb preservation. In addition,\nsecondary prevention of PAD has beenshown to reduce adverse cardiovascu-lar and limb outcomes. While a positivescreening test for PAD in an asymptom-atic ... | [
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0.04161... |
with increased cardiovascular event\nrates (233,234), prospective, randomizedstudies addressing whether screening forPAD in people with diabetes improveslong-term limb outcomes and cardiovas-cular event rates are limited. In therandomized controlled Viborg Vascular\n(VIVA) trial, 50,156 participants were ran- | [
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(VIVA) trial, 50,156 participants were ran-\ndomized to combined vascular screeningfor abdominal aortic aneurysm, PAD, andhypertension or to no screening. Vascularscreening was associated with increasedpharmacologic therapy (antiplatelet, lipid-lowering, and antihypertensive therapy),\nreduced in-hospital time for PAD ... | [
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reduced in-hospital time for PAD and\nCAD, and reduced mortality (235). There-fore, the committee recommends screen-ing for asymptomatic PAD using ankle-brachial index in people with diabetes athigh risk for PAD, including any of the fol-lowing: age $50 years, diabetes with du-\nration$10 years, comorbid microvascular | [
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0.02726087160408497,
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0.020910898223519325,
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0.05438889563083649,
0.0766160637140274,
0.007110158447176218,
0.03011... |
ration$10 years, comorbid microvascular\ndisease, clinical evidence of foot compli-cations, or any end-organ damage fromdiabetes. Therefore, the committee rec-ommends screening people with diabe-tes and high risk for PAD, includingage$50 years, diabetes with duration | [
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0.02582470141351223,
0.1107216328382492,
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0.02970185875892639,
0.029601071029901505,
-0.00009750297613209113,
-0.06705906987190247,
0.03... |
$10 years, microvascular disease, clini-cal evidence of foot complications, orany end-organ damage from diabetes.\nLifestyle and Pharmacologic\nInterventions\nIntensive lifestyle intervention focusing\non weight loss through decreased calo- | [
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0.04499778896570206,
0.03777220845222473,
0.03956708312034607,
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0.05405048280954361,
0.006713471841067076,
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-0.022955618798732758,
0.01... |
on weight loss through decreased calo-\nric intake and increased physical activity,as performed in the Action for Healthin Diabetes (Look AHEAD) trial, may beconsidered for improving glucose control,fitness, and some ASCVD risk factors | [
0.001001679920591414,
0.06073987856507301,
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0.05738048627972603,
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(236). Individuals at increased ASCVD riskshould receive statin, ACE inhibitor, orARB therapy if the individual has hyper-tension, and possibly aspirin, unless thereare contraindications to a particular drug\nclass.\nClear cardiovascular bene fit exists for\nACE inhibitor or ARB therapy in people\nwith diabetes. The Hea... | [
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0.021327869966626167,
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-0.008551317267119884,
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0.01594638265669346,
-0.02886126935482025,
... |
with diabetes. The Heart Outcomes Pre-\nvention Evaluation (HOPE) study random-\nized 9,297 individuals aged $55 years\nwith a history of vascular disease or dia-\nbetes plus one other cardiovascular risk\nfactor to either ramipril or placebo. Rami-\npril signi ficantly reduced cardiovascular | [
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0.04994896054267883,
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-0.011000902391970158,
0.07130372524261475,
0.0330049954354763,
-0.03803575783967972,
-0.001440962660126388,
0.04842682555317879,
-0.01893884316086769,
-0.045349... |
pril signi ficantly reduced cardiovascular\nand all-cause mortality, MI, and stroke(237). ACE inhibitors or ARB therapy alsohave well-established long-term benefi t\nin people with diabetes and diabetic kid-ney disease or hypertension, and these\nagents are recommended for hyperten- | [
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0.05229216814041138,
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0.025565050542354584,
0.0018842812860384583,
0.06485283374786377,
-0.0037147447001188993,
-0.01915154419839382,
0.053974900394678116,
0.09991585463285446,
-0.06838411837816238,
-0.0... |
agents are recommended for hyperten-\nsion management in people with knownASCVD (particularly coronary artery dis-\nease) (65,66,238). People with type 2 dia-\nbetes and CKD should be considered for\ntreatment with finerenone to reduce car-\ndiovascular outcomes and the risk of\nCKD progression (239 –242). b-Blockers | [
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-0.04966331273317337,
-0.001766714034602046,
-0.05873708799481392,
0.024704383686184883,
0.022433286532759666,
0.13447342813014984,
-0.02790624275803566,
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0.01137104444205761,
0.03150931000709534,
-0.12373146414756775,
0.01... |
CKD progression (239 –242). b-Blockers\nshould be used in individuals with activeangina or HFrEF and for 3 years after MI\nin those with preserved left ventricular\nfunction (243,244).\nGlucose-Lowering Therapies and\nCardiovascular Outcomes\nIn 2008, the FDA issued guidance for in-\ndustry to perform cardiovascular ou... | [
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0.00660593481734395,
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-0.01406967081129551,
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0.046658534556627274,
-0.12108565121889114,
0.05778531730175018,
-0.003847922431305051,
-0.05617080256342888,
-0.0034767899196594954,
0.018941761925816536,
-0.05826777592301369,
-0... |
dustry to perform cardiovascular out-\ncomes trials for all new medications for\nthe treatment of type 2 diabetes amid\nconcerns of increased cardiovascular risk\n(245). Previously approved diabetes medi-cations were not subject to the guidance.\nRecently published cardiovascular out-\ncomes trials have provided additi... | [
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0.06816596537828445,
0.02019638381898403,
-0.03168226778507233,
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0.0042420970275998116,
-0.0131111154332757,
0.06080623343586922,
-0.07997290790081024,
-0.005126861855387688,
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0.03905895724892616,
-0.06292008608579636,
-0.... |
comes trials have provided additional\ndata on cardiovascular and renal out-\ncomes in people with type 2 diabeteswith cardiovascular disease or at high risk\nfor cardiovascular disease ( Table 10.3A ,\nTable 10.3 B,a n d Table 10.3 C). An\nexpanded review of the effects of\nglucose-lowering and other therapiesin peopl... | [
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0.005079635884612799,
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0.025505000725388527,
-0.05798456817865372,
0.1244974434375763,
0.00985135231167078,
0.007989824749529362,
0.0015481446171179414,
0.08990759402513504,
-0.022725963965058327,
-0.0... |
tion 11, “Chronic Kidney Disease and\nRisk Management. ”\nCardiovascular outcomes trials of di-\npeptidyl peptidase 4 (DPP-4) inhibitors\nhave all, so far, not shown cardiovascularbenefits relative to placebo. In addition,\nthe CAROLINA (Cardiovascular OutcomeStudy of Linagliptin Versus Glimepiride in\nType 2 Diabetes) ... | [
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-0.005183892324566841,
-0.07718701660633087,
-0.03459784388542175,
-0.06210390850901604,
-0.015393276698887348,
-0.02986126020550728,
0.14814336597919464,
0.021961083635687828,
-0.01666695810854435,
-0.07469657063484192,
0.08607175201177597,
-0.07280125468969345,
0.01... |
Type 2 Diabetes) study demonstrated\nnoninferiority between a DPP-4 inhibitor,linagliptin, and a sulfonylurea, glimepir-\nide, on cardiovascular outcomes despiteS202 Cardiovascular Disease and Risk Management Diabetes Care Volume 47, Supplement 1, January 2024\n©AmericanDiabetesAssociation | [
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0.044121697545051575,
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-0.04162123426795006,
0.13065285980701447,
-0.013040320947766304,
-0.05060967803001404,
-0.04043205454945564,
0.07046301662921906,
-0.07114994525909424,
-0.... |
lower rates of hypoglycemia in the lina-\ngliptin treatment group (246). However,results from other new agents have pro-vided a mix of results.\nSGLT2 Inhibitor Trials\nThe Bl 10773 (Empagli flozin) Cardiovas-\ncular Outcome Event Trial in Type 2Diabetes Mellitus Patients (EMPA-REGOUTCOME) was a randomized, double-blind... | [
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0.013518944382667542,
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0.08874545246362686,
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empagli flozin, an SGLT2 inhibitor, versus\nplacebo on cardiovascular outcomes in\n7,020 people with type 2 diabetes andexisting cardiovascular disease. Study\nparticipants had a mean age of 63 years,\n57% had diabetes for over 10 years, and99% had established cardiovascular dis-ease. EMPA-REG OUTCOME showed that\nover ... | [
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over a median follow-up of 3.1 years,\ntreatment reduced the composite out-come of MI, stroke, and cardiovasculardeath by 14% (absolute rate 10.5% vs.\n12.1% in the placebo group, HR in the\nempagli flozin group 0.86 [95% CI 0.74 –\n0.99]; P= 0.04 for superiority) and car-\ndiovascular death by 38% (absolute rate3.7% vs... | [
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0.77]; P<0.001) (11).\nTwo large outcomes trials of the\nSGLT2 inhibitor canagli flozin have been\nconducted that separately assessed 1)\nthe cardiovascular effects of treatmentin individuals at high risk for major ad-\nverse cardiovascular events (12) and 2)\nthe impact of canagli flozin therapy on\ncardiorenal outcomes... | [
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cardiorenal outcomes in people with\ndiabetes-related CKD (247). First, the\nCANVAS Program integrated data fromtwo trials. The CANVAS trial that startedin 2009 was partially unblinded prior to\ncompletion because of the need to file\ninterim cardiovascular outcomes data for\nregulatory approval of the drug (248).Therea... | [
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Renal (CANVAS-R) trial was started in\n2014. Combining both trials, 10,142participants with type 2 diabetes wererandomized to canagli flozin or placebo\nand were followed for an average of\n3.6 years. The mean age of individuals\nwas 63 years, and 66% had a history ofcardiovascular disease. The combinedanalysis of the t... | [
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agliflozin signi ficantly reduced the com-\nposite outcome of cardiovascular death,\nMI, or stroke versus placebo (occurringin 26.9 vs. 31.5 participants per 1,000 pa-\ntient-years; HR 0.86 [95% CI 0.75– 0.97]).\nThe speci fic estimates for canagli flozinversus placebo on the primary composite | [
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cardiovascular outcome were HR 0.88(95% CI 0.75– 1.03) for the CANVAS trial\nand 0.82 (0.66 –1.01) for CANVAS-R, with\nno heterogeneity found between trials. Of\nnote, there was an increased risk of lower-\nlimb amputation with canagli flozin (6.3 vs.\n3.4 participants per 1,000 patient-years;HR 1.97 [95% CI 1.41– 2.75]... | [
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the Canagli flozin and Renal Events in Dia-\nbetes with Established Nephropathy ClinicalEvaluation (CREDENCE) trial randomized4,401 people with type 2 diabetes and\nchronic diabetes –related kidney disease\n(UACR >300 mg/g and eGFR 30 to\n<90 mL/min/1.73 m\n2)t oc a n a g l i flozin\n100 mg daily or placebo (247). The pr... | [
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2)t oc a n a g l i flozin\n100 mg daily or placebo (247). The primary\noutcome was a composite of end-stage\nkidney disease, doubling of serum creati-\nnine, or death from renal or cardiovascu-lar causes. The trial was stopped earlydue to conclusive evidence of ef ficacy\nidentifi ed during a prespeci fied interim | [
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identifi ed during a prespeci fied interim\nanalysis with no unexpected safety sig-nals. The risk of the primary compositeoutcome was 30% lower with canagli flo-\nzin treatment than with placebo (HR 0.70[95% CI 0.59– 0.82]). Moreover, it reduced\nthe prespeci fied end point of end-stage | [
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0.... |
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