Cited by 487Diabetes Treatment and ManagementDiabetes, Cardiovascular Risks, and LipoproteinsDiabetes Management and Research

10. Cardiovascular Disease and Risk Management: Standards of Medical Care in Diabetes—2020

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American Diabetes Association·2020·Diabetes Care

Abstract

The American Diabetes Association (ADA) “Standards of Medical Care in Diabetes” includes the ADA’s current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc20-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA’s clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc20-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

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  • SGLT2i and GLP1ra significantly reduce cardiovascular deaths independent of their effect on hyperglycemia.

    “Sodium-glucose co-transporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP1ra) are novel classes of medications for type 2 diabetes that significantly reduce cardiovascular deaths independent of their effect on hyperglycemia and are widely endorsed by clinical practice guidelines.4–11”

    From Disparities in Use of Novel Diabetes Medications by Insurance: A Nationally Representative Cohort Study (2024) · cites this paper as [9]

    The GLP-1 Receptor Agonist Trials section reports significant reductions in cardiovascular events with several SGLT2 inhibitors and GLP-1 receptor agonists, and recommends agents with demonstrated cardiovascular benefit for selected patients with type 2 diabetes. It does not establish that both classes significantly reduce cardiovascular deaths specifically or that those benefits are independent of their effects on hyperglycemia; the SGLT2 Inhibitor Trials section reports no difference in cardiovascular death in one trial. Page numbers were not available in our copy. (LLM, conf=0.87)

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  • SGLT2i and GLP1ra are widely endorsed by clinical practice guidelines.

    “Sodium-glucose co-transporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP1ra) are novel classes of medications for type 2 diabetes that significantly reduce cardiovascular deaths independent of their effect on hyperglycemia and are widely endorsed by clinical practice guidelines.4–11”
  • Professional society guidelines recommend GLP-1RA therapy for cardiovascular risk mitigation in patients with type 2 diabetes and established ASCVD or multiple ASCVD risk factors, independent of glucose control or background antihyperglycemic therapy.

    “Professional society guidelines now recommend GLP-1RA therapy for cardiovascular risk mitigation in patients with type 2 diabetes and established atherosclerotic cardiovascular disease (ASCVD) or multiple ASCVD risk factors, independent of glucose control or background antihyperglycemic therapy (other diabetes medications being used).”
  • Society recommendations and guidelines support the concurrent use of GLP-1RAs and SGLT2 inhibitors when needed for adequate glycemic control, but data on whether such combinations yield incremental cardiovascular advantages are lacking.

    “Society recommendations and guidelines support the concurrent use of GLP-1RAs and SGLT2 inhibitors when needed for adequate glycemic control, but data on whether such combinations may yield incremental cardiovascular advantages are lackingthusfar.15,16,21”

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2 of the 181 references couldn’t be matched to a known paper.

Research works printed but not linked: 11

  1. Bangalore S, Kumar S, Lobach I, Messerli FH. Blood pressure targets in subjects with type 2 diabetes mellitus/impaired fasting glucose: ob- servations from traditional and Bayesian ran- dom-effects meta-analyses of randomized trials. Circulation 2011;123:2799-2810
  2. American College of Obstetricians and Gy- necologists; Task Force on Hypertension in Preg- nancy. Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecol- ogists' Task Force on Hypertension in Pregnancy. Obstet Gynecol 2013;122:1122-1131
  3. Irgens HU, Reisaeter L, Irgens LM, Lie RT. Long term mortality of mothers and fathers after pre-eclampsia: population based cohort study. BMJ 2001;323:1213-1217
  4. Webster R, Salam A, de Silva HA, Selak V, Stepien S, Rajapakse S, et al. Fixed low-dose triple combination antihypertensive medication vs usual care for blood pressure control in patients with mild to moderate hypertension in Sri Lanka: a randomized clinical trial. JAMA 2018;320:566- 579
  5. Yusuf S, Teo KK, Pogue J, et al.; ONTARGET Investigators. Telmisartan, ramipril, or both in College of Cardiology Task Force on Expert Consensus Decision Pathways. J Am Coll Cardiol 2018;72:3200-3223
  6. Yusuf S, Bosch J, Dagenais G, et al.; HOPE-3 Investigators. Cholesterol lowering in interme- diate-risk persons without cardiovascular dis- ease. N Engl J Med 2016;374:2021-2031 118.
  7. Belch J, MacCuish A, Campbell I, et al. The prevention of progression of arterial disease and diabetes (POPADAD) trial: factorial randomised placebo controlled trial of aspirin and antiox- idants in patients with diabetes and asymptom- atic peripheral arterial disease. BMJ 2008;337: a1840 123.
  8. Bethel MA, Harrison P, Sourij H, et al. Randomized controlled trial comparing impact on platelet reactivity of twice-daily with once- daily aspirin in people with type 2 diabetes. Diabet Med 2016;33:224-230 141.
  9. Zelniker TA, Wiviott SD, Raz I, et al. Com- parison of the effects of glucagon-like peptide receptor agonists and sodium-glucose cotrans- porter 2 inhibitors for prevention of major adverse cardiovascular and renal outcomes in type 2 diabetes mellitus. Circulation 2019;139: 2022-2031 173.
  10. Lincoff AM, Wolski K, Nicholls SJ, Nissen SE. Pioglitazone and risk of cardiovascular events in patientswithtype2diabetesmellitus:ameta-analysis of randomized trials. JAMA 2007;298:1180-1188 178.
  11. Rosenstock J, Perkovic V, Johansen OE, et al. Effect of linagliptin vs placebo on major cardiovascular events in adults with type 2 di- abetes and high cardiovascular and renal risk: the CARMELINA randomized clinical trial. JAMA 2019;321:69-79 185.

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Authors
American Diabetes Association
Venue
Diabetes Care
Published
2019-12-16
Volume
43
Issue
Supplement_1
Pages
S111-S134
ISSN
  • 0149-5992 (ISSN-L)
  • 1935-5548
OpenAlex
W4254135372
Cited by
487
References
181
Citations by year
2026: 5 · 2025: 20 · 2024: 44 · 2023: 61 · 2022: 89 · 2021: 137 · 2020: 131
FWCI
72.66
Type
journal article
Language
en
Open access
Locations
  • Diabetes Care (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
Keywords
cardiovascular disease, cardiovascular risk management, diabetes mellitus, clinical guidelines, quality of care
MeSH terms
Heart Disease Risk Factors, Cardiovascular Diseases, Diabetes Mellitus, Diabetic Angiopathies, Endocrinology, Humans, Reference Standards, Societies, Medical, United States, History, 21st Century, Standard of Care

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