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      Latin American Expert Consensus for Comprehensive Management of Type 2 Diabetes from a Metabolic–Cardio–Renal Perspective for the Primary Care Physician

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          Abstract

          Growing scientific evidence from studies on type 2 diabetes (T2D) has recently led to a better understanding of the associated metabolic–cardio–renal risks. The large amount of available information makes it essential to have a practical guide that summarizes the recommendations for the initial management of patients with T2D, integrating different aspects of endocrinology, cardiology, and nephrology. The expert consensus presented here does not attempt to summarize all the evidence in this regard but rather attempts to define practical summary recommendations for the primary care physician to improve the clinical prognosis and management of patients with T2D, while ensuring economic sustainability of health systems, beyond glycemic control.

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          A new equation to estimate glomerular filtration rate.

          Andrew Levey, Lesley Stevens, Christopher H Schmid … (2009)
          Equations to estimate glomerular filtration rate (GFR) are routinely used to assess kidney function. Current equations have limited precision and systematically underestimate measured GFR at higher values. To develop a new estimating equation for GFR: the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Cross-sectional analysis with separate pooled data sets for equation development and validation and a representative sample of the U.S. population for prevalence estimates. Research studies and clinical populations ("studies") with measured GFR and NHANES (National Health and Nutrition Examination Survey), 1999 to 2006. 8254 participants in 10 studies (equation development data set) and 3896 participants in 16 studies (validation data set). Prevalence estimates were based on 16,032 participants in NHANES. GFR, measured as the clearance of exogenous filtration markers (iothalamate in the development data set; iothalamate and other markers in the validation data set), and linear regression to estimate the logarithm of measured GFR from standardized creatinine levels, sex, race, and age. In the validation data set, the CKD-EPI equation performed better than the Modification of Diet in Renal Disease Study equation, especially at higher GFR (P < 0.001 for all subsequent comparisons), with less bias (median difference between measured and estimated GFR, 2.5 vs. 5.5 mL/min per 1.73 m(2)), improved precision (interquartile range [IQR] of the differences, 16.6 vs. 18.3 mL/min per 1.73 m(2)), and greater accuracy (percentage of estimated GFR within 30% of measured GFR, 84.1% vs. 80.6%). In NHANES, the median estimated GFR was 94.5 mL/min per 1.73 m(2) (IQR, 79.7 to 108.1) vs. 85.0 (IQR, 72.9 to 98.5) mL/min per 1.73 m(2), and the prevalence of chronic kidney disease was 11.5% (95% CI, 10.6% to 12.4%) versus 13.1% (CI, 12.1% to 14.0%). The sample contained a limited number of elderly people and racial and ethnic minorities with measured GFR. The CKD-EPI creatinine equation is more accurate than the Modification of Diet in Renal Disease Study equation and could replace it for routine clinical use. National Institute of Diabetes and Digestive and Kidney Diseases.
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            Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes.

            Bernard Zinman, Christoph Wanner, John M. Lachin … (2015)
            The effects of empagliflozin, an inhibitor of sodium-glucose cotransporter 2, in addition to standard care, on cardiovascular morbidity and mortality in patients with type 2 diabetes at high cardiovascular risk are not known.
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              Dapagliflozin and Cardiovascular Outcomes in Type 2 Diabetes

              Stephen Wiviott, Itamar Raz, Marc Bonaca … (2018)
              The cardiovascular safety profile of dapagliflozin, a selective inhibitor of sodium-glucose cotransporter 2 that promotes glucosuria in patients with type 2 diabetes, is undefined.
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                Author and article information

                Contributors
                Roopa Mehta:
                ORCID: http://orcid.org/0000-0002-2509-8054
                roopamehta@yahoo.com
                Journal
                Journal ID (nlm-ta): Diabetes Ther
                Journal ID (iso-abbrev): Diabetes Ther
                Title: Diabetes Therapy
                Publisher: Springer Healthcare (Cheshire )
                ISSN (Print): 1869-6953
                ISSN (Electronic): 1869-6961
                Publication date (Electronic): 15 December 2020
                Publication date PMC-release: 15 December 2020
                Publication date (Print): January 2021
                Volume: 12
                Issue: 1
                Pages: 1-20
                Affiliations
                [1 ]GRID grid.416850.e, ISNI 0000 0001 0698 4037, Metabolic Diseases Research Unit (UIEM), , National Institute of Medical Sciences and Nutrition Salvador Zubirán (INCMNSZ), ; Vasco De Quiroga 15, Belisario Dominguez, Tlalpan 14200 Mexico
                [2 ]Department of Medicine/Cardiology, Hospital Paitilla, Calle 53, Ave Balboa, Urb. Marbella, Panama City, 00134 Panama
                [3 ]Clínica Los Yoses, San Pedro Montes de Oca, San José, Costa Rica
                [4 ]GRID grid.412714.5, ISNI 0000 0004 0426 1806, Department of Nephrology, , Fundación Favaloro University Hospital, ; Buenos Aires, 1093 Argentina
                [5 ]GRID grid.419157.f, ISNI 0000 0001 1091 9430, Coordinacion de Planeacion de Infraestructura Medica, , Instituto Mexicano del Seguro Social, ; C.P. 6700, Mexico City, Mexico
                [6 ]Cardiología Clínica e Intervencionista, 44670 Guadalajara, Jalisco Mexico
                [7 ]Clinica del Café, Armenia, Quindio Colombia
                [8 ]Instituto de Cardiología y Cirugía Cardiovascular, Buenos Aires, Argentina
                [9 ]GRID grid.477264.4, Internal Medicine/Cardiology, , Fundación Valle del Lili, ; Cali, 760026 Colombia
                [10 ]GRID grid.418248.3, ISNI 0000 0004 0637 5938, Cardiology Section, Cardiovascular Prevention Unit, , CEMIC, ; Buenos Aires, Argentina
                [11 ]GRID grid.477064.6, ISNI 0000 0004 0604 1831, Centro de Diabetes Adultos, , Clinica Las Condes, ; 7591047 Santiago, Chile
                [12 ]GRID grid.411087.b, ISNI 0000 0001 0723 2494, Department of Cardiology, , State University of Campinas (Unicamp), ; Campinas, Brazil
                Author information
                http://orcid.org/0000-0002-2509-8054
                Article
                Publisher ID: 961
                DOI: 10.1007/s13300-020-00961-4
                PMC ID: 7843679
                PubMed ID: 33325006
                SO-VID: 965aa006-2af7-459d-8e34-da409fb73d4f
                Copyright © © The Author(s) 2020
                License:

                Open Access This article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/4.0/.

                History
                Date received : 16 September 2020
                Date accepted : 27 October 2020
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100004325, AstraZeneca;
                Categories
                Subject: Guidelines
                Custom metadata
                issue-copyright-statement © The Author(s) 2021

                ScienceOpen disciplines: Endocrinology & Diabetes
                Keywords: antidiabetic drugs,cardiovascular disease,heart failure,hypoglycemia,type 2 diabetes mellitus
                Data availability:
                ScienceOpen disciplines: Endocrinology & Diabetes
                Keywords: antidiabetic drugs, cardiovascular disease, heart failure, hypoglycemia, type 2 diabetes mellitus

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