Awareness that type 2 diabetes is often associated with coronary artery disease, hypertension, and heart failure has become more pronounced in recent years. In addition to modern SGLT2 inhibitors and GLP-1 receptor agonists, which have significantly changed treatment, the international “Guardians for Health” initiative also aims to reduce mortality and cardiovascular and renal complications in people with type 2 diabetes.
Modern diabetes therapy is about skillfully combining the various therapeutic principles and additional benefits to create synergies. Individualized treatment should be determined for each type 2 diabetes patient, with the ideal drug being effective over the long term, well tolerated with no or few side effects, preferably combinable with other medications, protecting the heart, blood vessels and kidneys, and reducing weight.
Additional benefit influences choice of therapy
A synergistic effect can be achieved, for example, by combining insulin and a GLP-1 receptor agonist (GLP-1-RA). Insulin lowers blood glucose levels, and GLP-1-RA prevents the patient from gaining weight while on insulin. In addition, GLP-1-RA show a protective effect on the cardiovascular system. The preparations are applied daily or weekly and are available both as injections and tablets. However, the different half-lives influence the effect: short-acting GLP-1-RAs inhibit gastric emptying and mainly affect postprandial blood glucose, whereas long-acting preparations have more of an effect on fasting blood glucose.
The most recent antidiabetic agents for the treatment of type 2 diabetes are SGLT-2 inhibitors. They promote renal glucose excretion by inhibiting renal glucose reabsorption. In addition to lowering blood sugar levels, weight loss occurs. Primarily visceral fat is lost. SGLT-2 inhibitors have been shown to reduce cardiovascular morbidity and mortality and have additional renal benefits by reducing intraglomerular pressure. For this reason, they can also be used to treat diabetic kidney disease [1].
Diabetes comorbidities in focus
The global Guardians for Health initiative also aims to improve medical care and quality of life for people with type 2 diabetes by reducing cardiovascular and renal complications. The vision includes preventing premature deaths by counteracting cardiovascular and renal complications. In addition to the implementation of guidelines, the initiative is also committed to enabling physicians and patients with type 2 diabetes to make shared decisions that best fit their personal life situations through participatory decision making.
A three-pillar strategy is being pursued. Whereby the first pillar is the establishment of a network of medical experts, which should create a forum for exchange and implement pragmatic solutions on a local, national and international level. The second pillar aims to provide strategies and tools to help physicians implement guideline recommendations and to enable people with type 2 diabetes to take a more active role in managing their disease. The third pillar is for quality assurance. Here, strategies will be developed to improve the treatment of type 2 diabetes. This includes medical education that emphasizes cardiorenal protection measures.
Necessary information such as tools to facilitate education and training, as well as up-to-date information on Standards of Care, can be found on the international website “www.guardiansforhealth.com” or the local website “www.diabetes-herz-niere.de” [2].
Literature:
- Stefan Fischli: New drugs in the therapy of type 2 diabetes. 12th Swiss-German Diabetic Day, 13.11.2021.
- Petra Sandow: Goals of the initiative and the holistic view of the patient with type 2 diabetes mellitus, Berlin (D), 01.05.2022, Industrie Symposium DGIM.
HAUSARZT PRAXIS 2022; 17(6): 44
