{"id":334271,"date":"2020-05-27T13:40:55","date_gmt":"2020-05-27T11:40:55","guid":{"rendered":"https:\/\/medizinonline.com\/diabetes-treatment-for-increased-risk-to-heart-and-kidney\/"},"modified":"2020-05-27T13:40:55","modified_gmt":"2020-05-27T11:40:55","slug":"diabetes-treatment-for-increased-risk-to-heart-and-kidney","status":"publish","type":"post","link":"https:\/\/medizinonline.com\/en\/diabetes-treatment-for-increased-risk-to-heart-and-kidney\/","title":{"rendered":"Diabetes treatment for increased risk to heart and kidney"},"content":{"rendered":"<p>How should a typical diabetic patient, 55-year-old, obese, with hypertension, dyslipidemia, and reduced renal function be treated?<\/p>\n<p><!--more--><\/p>\n<p><iframe data-src=\"https:\/\/player.vimeo.com\/video\/422831249\" width=\"640\" height=\"480\" frameborder=\"0\" src=\"data:image\/svg+xml;base64,PHN2ZyB3aWR0aD0iMSIgaGVpZ2h0PSIxIiB4bWxucz0iaHR0cDovL3d3dy53My5vcmcvMjAwMC9zdmciPjwvc3ZnPg==\" class=\"lazyload\" data-load-mode=\"1\"><\/iframe><\/p>\n<h2 id=\"therapy-recommendation\"><strong>Therapy recommendation<\/strong><\/h2>\n<p>In the following, I would like to present my recommendations for the optimal treatment of the 55-year-old, newly diagnosed T2DM patient presented in the video above.<\/p>\n<p>In addition to his T2DM, the patient suffers from visceral obesity, arterial hypertension, classic dyslipidemia, and chronic renal insufficiency with microalbuminuria, among other conditions. His HbA1c level was 10.5% at the time of presentation.<\/p>\n<p>Overall, the patient has a high to very high cardiovascular risk, which means that his LDC-C target value according to the current guidelines is &gt;1.8 and &gt;1.4 mmol\/l, respectively. In addition, a reduction in systolic blood pressure to 120 &#8211; 140 mmHg and diastolic blood pressure to 70 &#8211; 80 mmHg should be achieved.<\/p>\n<p>I would recommend a triple combination of metformin, a GLP-1 RA, and an SGLT-2 inhibitor as the optimal therapy for this patient. Unfortunately, this triple therapy is not yet reimbursed by health insurers, although its benefits in terms of 3-point MACE, severe hypoglycemia, and total mortality have been demonstrated quite clearly in a Danish real-world study [1].<\/p>\n<p>Considering the reimbursement situation and the patient&#8217;s preferences, I would treat the patient with canagliflozin (Invokana\u00ae, 100mg, 1-0-0) and with sitagliptin\/metformin (Janumet\u00ae, 50mg \/1000mg, 1-0-1) to better manage their diabetes. Since T2DM has only recently been discovered and the patient does not yet want injection therapy, a GLP1-1 RA is rather out of the question at this point.<\/p>\n<p>For treatment of hypertension and dyslipidemia, I recommend atorvastatin\/perindopril\/amlodipine (Triveram\u00ae, 40mg\/10mg\/10mg, 1-0-0).<\/p>\n<p>In addition, the patient should present for follow-up after one month.<\/p>\n<p><span style=\"font-size: 10px;\">References<\/span><\/p>\n<p><span style=\"font-size: 11px;\">1. Jensen, M.H., et al, Risk of Major Adverse Cardiovascular Events, Severe Hypoglycemia, and All-Cause Mortality for Widely Used Antihyperglycemic Dual and Triple Therapies for Type 2 Diabetes Management: A Cohort Study of All Danish Users. Diabetes Care, 2020. 43(6): p. 1209-1218.<\/span><\/p>\n<p><span style=\"font-size: 12px;\"><em>Explanations: Prof. Roger Lehmann, MD, with editorial assistance from Dr. rer. nat. Jennifer Keim, IACULIS GmbH. Copyright and responsibility for the content of the patient case rests exclusively with the author.<\/em><\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>How should a typical diabetic patient, 55-year-old, obese, with hypertension, dyslipidemia, and reduced renal function be treated?<\/p>\n","protected":false},"author":12,"featured_media":97171,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"pmpro_default_level":"","cat_1_feature_home_top":false,"cat_2_editor_pick":false,"csco_eyebrow_text":"Diabetes Cases","footnotes":""},"category":[11323,11548],"tags":[],"powerkit_post_featured":[],"class_list":["post-334271","post","type-post","status-publish","format-standard","has-post-thumbnail","category-partner-content-en","category-rx-en","pmpro-has-access"],"acf":[],"publishpress_future_action":{"enabled":false,"date":"2026-04-11 01:17:38","action":"change-status","newStatus":"draft","terms":[],"taxonomy":"category","extraData":[]},"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"wpml_current_locale":"en_US","wpml_translations":{"fr_FR":{"locale":"fr_FR","id":334277,"slug":"traitement-du-diabete-en-cas-de-risque-accru-pour-le-coeur-et-les-reins","post_title":"Traitement du diab\u00e8te en cas de risque accru pour le c\u0153ur et les reins","href":"https:\/\/medizinonline.com\/fr\/traitement-du-diabete-en-cas-de-risque-accru-pour-le-coeur-et-les-reins\/"},"it_IT":{"locale":"it_IT","id":334251,"slug":"trattamento-del-diabete-per-laumento-del-rischio-di-malattie-cardiache-e-renali","post_title":"Trattamento del diabete per l'aumento del rischio di malattie cardiache e renali","href":"https:\/\/medizinonline.com\/it\/trattamento-del-diabete-per-laumento-del-rischio-di-malattie-cardiache-e-renali\/"},"pt_PT":{"locale":"pt_PT","id":334261,"slug":"tratamento-da-diabetes-para-o-aumento-do-risco-de-doencas-cardiacas-e-renais","post_title":"Tratamento da diabetes para o aumento do risco de doen\u00e7as card\u00edacas e renais","href":"https:\/\/medizinonline.com\/pt-pt\/tratamento-da-diabetes-para-o-aumento-do-risco-de-doencas-cardiacas-e-renais\/"},"es_ES":{"locale":"es_ES","id":334267,"slug":"tratamiento-de-la-diabetes-para-aumentar-el-riesgo-de-enfermedades-cardiacas-y-renales","post_title":"Tratamiento de la diabetes para aumentar el riesgo de enfermedades cardiacas y renales","href":"https:\/\/medizinonline.com\/es\/tratamiento-de-la-diabetes-para-aumentar-el-riesgo-de-enfermedades-cardiacas-y-renales\/"}},"_links":{"self":[{"href":"https:\/\/medizinonline.com\/en\/wp-json\/wp\/v2\/posts\/334271","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medizinonline.com\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medizinonline.com\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/medizinonline.com\/en\/wp-json\/wp\/v2\/users\/12"}],"replies":[{"embeddable":true,"href":"https:\/\/medizinonline.com\/en\/wp-json\/wp\/v2\/comments?post=334271"}],"version-history":[{"count":0,"href":"https:\/\/medizinonline.com\/en\/wp-json\/wp\/v2\/posts\/334271\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/medizinonline.com\/en\/wp-json\/wp\/v2\/media\/97171"}],"wp:attachment":[{"href":"https:\/\/medizinonline.com\/en\/wp-json\/wp\/v2\/media?parent=334271"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medizinonline.com\/en\/wp-json\/wp\/v2\/category?post=334271"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medizinonline.com\/en\/wp-json\/wp\/v2\/tags?post=334271"},{"taxonomy":"powerkit_post_featured","embeddable":true,"href":"https:\/\/medizinonline.com\/en\/wp-json\/wp\/v2\/powerkit_post_featured?post=334271"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}