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CME / ABIM MOC

Cardiovascular/Renal Risk Reduction and SGLT2 Inhibitors. Where Are We Now?

  • Authors: Christopher P. Cannon, MD
  • CME / ABIM MOC Released: 10/26/2022
  • Valid for credit through: 10/26/2023
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  • Credits Available

    Physicians - maximum of 0.25 AMA PRA Category 1 Credit(s)™

    ABIM Diplomates - maximum of 0.25 ABIM MOC points

    You Are Eligible For

    • Letter of Completion
    • ABIM MOC points

Target Audience and Goal Statement

This activity is intended for diabetologists and endocrinologists, cardiologists, and primary care physicians.

The goal of this activity is for learners to be better able to interpret the practical implications of new data on the use of SGLT2 inhibitors in patients with type 2 diabetes (T2D) and cardiovascular disease (CVD), heart failure (HF), and/or chronic kidney disease (CKD).

Upon completion of this activity, participants will:

  • Have increased knowledge regarding the
    • New data from the European Society of Cardiology (ESC) and European Association for the Study of Diabetes (EASD) 2022 meetings related to the use of SGLT2 inhibitors in patients with T2D and CVD/CKD
    • Implications of new data for SGLT2 inhibitors on practice


Disclosures

Medscape, LLC requires every individual in a position to control educational content to disclose all financial relationships with ineligible companies that have occurred within the past 24 months. Ineligible companies are organizations whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

All relevant financial relationships for anyone with the ability to control the content of this educational activity are listed below and have been mitigated. Others involved in the planning of this activity have no relevant financial relationships.


Faculty

  • Christopher P. Cannon, MD

    Professor of Medicine
    Harvard Medical School
    Senior Physician
    Cardiovascular Division
    Brigham and Women's Hospital
    Boston, Massachusetts

    Disclosures

    Christopher P. Cannon, MD, has the following relevant financial relationships:
    Consultant or advisor for: Aegerion; Alnylam; Amarin; Amgen; Amryt; Applied Therapeutics; Ascendia Pharmaceuticals; Boehringer Ingelheim; Bristol Myers Squibb Company; Janssen; Lexicon Pharmaceuticals; Lilly; Merck; Pfizer; Rhoshan; Sanofi
    Research funding from: Amgen; Better Therapeutics; Boehringer Ingelheim; Bristol Myers Squibb Company; Daiichi Sankyo; Janssen; Merck; Novo Nordisk; Pfizer

Editors

  • Jennifer Hakkarainen, PA-C

    Medical Education Director, Medscape, LLC

    Disclosures

    Jennifer Hakkarainen, PA-C, has no relevant financial relationships.

  • Gina Montanero, PharmD

    Associate Medical Writer, Medscape, LLC

    Disclosures

    Gina Montanero, PharmD, has no relevant financial relationships.

Compliance Reviewer

  • Leigh Schmidt, MSN, RN, CNE, CHCP

    Associate Director, Accreditation and Compliance, Medscape, LLC

    Disclosures

    Leigh Schmidt, MSN, RN, CNE, CHCP, has no relevant financial relationships.

Peer Reviewer

This activity has been peer reviewed and the reviewer has no relevant financial relationships.


Accreditation Statements



In support of improving patient care, Medscape, LLC is jointly accredited with commendation by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

    For Physicians

  • Medscape, LLC designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™ . Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 0.25 MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit. Aggregate participant data will be shared with commercial supporters of this activity.

    Contact This Provider

For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact [email protected]


Instructions for Participation and Credit

There are no fees for participating in or receiving credit for this online educational activity. For information on applicability and acceptance of continuing education credit for this activity, please consult your professional licensing board.

This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page. To receive AMA PRA Category 1 Credit™, you must receive a minimum score of 70% on the post-test.

Follow these steps to earn CME/CE credit*:

  1. Read about the target audience, learning objectives, and author disclosures.
  2. Study the educational content online or print it out.
  3. Online, choose the best answer to each test question. To receive a certificate, you must receive a passing score as designated at the top of the test. We encourage you to complete the Activity Evaluation to provide feedback for future programming.

You may now view or print the certificate from your CME/CE Tracker. You may print the certificate, but you cannot alter it. Credits will be tallied in your CME/CE Tracker and archived for 6 years; at any point within this time period, you can print out the tally as well as the certificates from the CME/CE Tracker.

*The credit that you receive is based on your user profile.

CME / ABIM MOC

Cardiovascular/Renal Risk Reduction and SGLT2 Inhibitors. Where Are We Now?

Authors: Christopher P. Cannon, MDFaculty and Disclosures

CME / ABIM MOC Released: 10/26/2022

Valid for credit through: 10/26/2023

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References

  1. Davies MJ, et al. Management of hyperglycemia in type 2 diabetes, 2022. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2022. doi:10.2337/dci22-0034 [Epub ahead of print]
  2. McGuire DK, et al. Association of SGLT2 inhibitors with cardiovascular and kidney outcomes in patients with type 2 diabetes. JAMA Cardiol. 2021;6:148-158.
  3. Giugliano D, et al. GLP-1 receptor agonists and cardiorenal outcomes in type 2 diabetes: an updated meta-analysis of eight CVOTs. Cardiovasc Diabetol. 2021;20:189.
  4. Kristensen SL, et al. Cardiovascular, mortality, and kidney outcomes with GLP-1 receptor agonists in patients with type 2 diabetes: a systematic review and meta-analysis of cardiovascular outcome trials. Lancet Diabetes Endocrinol. 2019;7:776-785.
  5. Sattar N, et al. Cardiovascular, mortality, and kidney outcomes with GLP-1 receptor agonists in patients with type 2 diabetes: a systematic review and meta-analysis of randomised trials. Lancet Diabetes Endocrinol. 2021;9:640-641.
  6. American Diabetes Association (ADA). 10. Cardiovascular disease and risk management: standards of medical care in diabetes -- 2022. Diabetes Care. 2021;45(Suppl 1):S144-S174.
  7. Cosentino F, et al; ESC Scientific Document Group. 2019 ESC guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Eur Heart J. 2020;41:255-323.
  8. Davies MJ, et al. Cardiovascular outcomes trials: a paradigm shift in the current management of type 2 diabetes. Cardiovasc Diabetol. 2022;21:144.
  9. Solomon SD, et al; DELIVER Trial Committees and Investigators; DELIVER Trial Committee and Investigators. Dapagliflozin in heart failure with mildly reduced or preserved ejection fraction. N Engl J Med. 2022;387:1089-1098.
  10. McMurray JJV, et al; DAPA-HF Trial Committees and Investigators. Dapagliflozin in patients with heart failure and reduced ejection fraction. N Engl J Med. 2019;381:1995-2008.
  11. Packer M, et al; EMPEROR-Reduced Trial Investigators. Cardiovascular and renal outcomes with empagliflozin in heart failure. N Engl J Med. 2020;383:1413-1424.
  12. Writing Committee Members; ACC/AHA Joint Committee Members. 2022 ACC/AHA/HFSA guideline for the management of heart failure. J Card Fail. 2022;28:e1-e167.
  13. Anker SD, et al; EMPEROR-Preserved Trial Investigators. Empagliflozin in heart failure with a preserved ejection fraction. N Engl J Med. 2021;385:1451-1461.
  14. Cunningham JW, et al. Dapagliflozin in patients recently hospitalized with heart failure and mildly reduced or preserved ejection fraction. J Am Coll Cardiol. 2022;80:1302-1310.
  15. Butt JH, et al. Efficacy and safety of dapagliflozin according to frailty in heart failure with reduced ejection fraction: a post hoc analysis of the DAPA-HF trial. Ann Intern Med. 2022;175:820-830.
  16. Adamson C, et al. Dapagliflozin for heart failure according to body mass index: the DELIVER trial. Eur Heart J. 2022. doi:10.1093/eurheartj/ehac481. [Epub ahead of print]
  17. Butt JH, et al. Dapagliflozin, atrial fibrillation, and heart failure with mildly reduced or preserved ejection fraction in DELIVER. J Am Coll Cardiol. 2022. doi:10.1016/j.jacc.2022.08.718. [Epub ahead of print]
  18. Ostrominski JW, et al. Dapagliflozin and New York Heart Association functional class in heart failure with mildly reduced or preserved ejection fraction: the DELIVER trial. Eur J Heart Fail. 2022. doi:10.1002/ejhf.2652. [Epub ahead of print]
  19. Myhre PL, et al. Influence of NT-proBNP on efficacy of dapagliflozin in heart failure with mildly reduced or preserved ejection fraction. JACC Heart Fail. 2022. doi:10.1016/j.jchf.2022.08.007. [Epub ahead of print]
  20. Vaduganathan M, et al. SGLT-2 inhibitors in patients with heart failure: a comprehensive meta-analysis of five randomised controlled trials. Lancet. 2022;400:757-767.
  21. Jhund PS, et al. Dapagliflozin across the range of ejection fraction in patients with heart failure: a patient-level, pooled meta-analysis of DAPA-HF and DELIVER. Nat Med. 2022;28:1956-1964.
  22. Pandey A, et al. Efficacy of ertugliflozin on hospitalisation for heart failure across the distribution of pre-trial ejection fraction: post hoc analyses of the VERTIS CV trial. Presented at: The European Society of Cardiology (ESC) Congress; August 26-29, 2022; Barcelona, Spain.
  23. Pandey A, et al. Efficacy of ertugliflozin (ERTU) on hospitalisation for heart failure (HHF) across the spectrum of pre-trial ejection fraction (EF): post hoc analyses of VERTIS CV. Presented at: The European Association for the Study of Diabetes (EASD) 58th Annual Meeting; September 19-23, 2022; Stockholm, Sweden. Abstract 252.
  24. Cannon CP, et al. Cardiovascular outcomes with ertugliflozin in type 2 diabetes. N Engl J Med 2020; 383:1425-1435.
  25. Nesti L, et al. Effect of empagliflozin on left ventricular contractility and peak oxygen uptake in subjects with type 2 diabetes without heart disease: results of the EMPA-HEART trial. Presented at: The European Association for the Study of Diabetes (EASD) 58th Annual Meeting; September 19-23, 2022; Stockholm, Sweden. Abstract 249.
  26. Perkovic V, et al; CREDENCE Trial Investigators. Canagliflozin and renal outcomes in type 2 diabetes and nephropathy. N Engl J Med. 2019;380:2295-2306.
  27. Heerspink HJL, et al. Dapagliflozin in patients with chronic kidney disease. N Engl J Med. 2020;383:1436-1446.
  28. Fornell D. American Heart Association 2022 late-breaking studies announced. September 26, 2022. Accessed October 6, 2022. https://cardiovascularbusiness.com/topics/professional-associations/cardiology-associations/american-heart-association-aha/american
  29. KDIGO Chronic Kidney Disease Guideline Development Work Group Members. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl. 2013;3:1-150.
  30. KKDIGO. KDIGO announces launch of CKD guideline update. January 26, 2022. Accessed October 6, 2022. https://kdigo.org/kdigo-announces-launch-of-ckd-guideline-update/
  31. Inzucchi SE, et al. Shifts in KDIGO CKD risk groups with empagliflozin: reno-protection from SGLT2 inhibition across the spectrum of risk. Presented at: The European Association for the Study of Diabetes (EASD) 58th Annual Meeting; September 19-23, 2022; Stockholm, Sweden. Abstract 88.
  32. Goldman A. The real-world safety profile of SGLT2 inhibitors among adults 75 years or older: a retrospective, pharmacovigilance study. Presented at: The European Society of Cardiology (ESC) Congress; August 26-29, 2022; Barcelona, Spain.
  33. Cherney DZI, et al; VERTIS CV Investigators. Initial eGFR changes with ertugliflozin and associations with clinical parameters: analyses from the VERTIS CV Trial. Am J Nephrol. 2022;53:516-525.
  34. Sridhar VS, et al. Effects of ertugliflozin on uric acid and gout-related outcomes: post hoc analyses from VERTIS CV. Presented at: The European Association for the Study of Diabetes (EASD) 58th Annual Meeting; September 19-23, 2022; Stockholm, Sweden. Abstract 621.
  35. Cosentino F, et al. Cardiorenal outcomes with ertugliflozin by baseline metformin use: post hoc analyses of the VERTIS CV Trial. Circulation. 2022;146:652-654.
  36. Shin H, et al. Cardiovascular outcomes in patients initiating first-line treatment of type 2 diabetes with sodium-glucose cotransporter-2 inhibitors versus metformin: a cohort study. Ann Intern Med. 2022;175:927-937.
  37. de Boer IH, et al. Diabetes management in chronic kidney disease: a consensus report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO). Diabetes Care. 2022:dci220027.
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