Professor Nikolaus Marx from Aachen University, Germany, speaks to Cardio Debate & Radcliffe Cardiology about what’s new in the management of Diabetes during the ESC2016 Congress held in Rome, Italy.
The most critical point that we learned over the past few years is that therapy should be individualised, with Hb1c targets below seven as the regular target, and more stringent targets in young patients without cardiovascular disease, and more loose targets in subjects with higher age or comorbidities.
In addition to that, we learned that we should avoid side effects such as hypoglycemia or weight gain.
Why do we have anti-diabetes drugs improving CV outcomes and what are the mechanisms of action that makes them effective?
For years we haven’t seen trials reducing cardiovascular events with anti-diabetic drugs. But only recently the EMPA-REG OUTCOME trial testing empagliflozin and SGLT2 inhibitors versus placebo showed a reduction in cardiovascular events, driven by cardiovascular death and hospitalization and heart failure. In addition to that GLP-1 analogue reduced cardiovascular events in the LEADER trial.
The mechanisms are unclear, but as far as we know today it is not glucose-lowering, or glucose-lowering alone, but additional effects such as weight loss, or as of yet unknown effects may have contributed to the results.
Is there anything on the horizon in terms of further CV outcome data?
There are a couple of cardiovascular outcome trials that are coming – trials with the agents that I mentioned, with the SGLT2 inhibitors and the GLP-1 analogues. In addition to that there is the CAROLINA trial comparing Linagliptin, a DPP-4 inhibitor – versus a sulphonylurea, so challenging our current concept that the second important drug after metformin is sulphonylurea, and the study is testing whether Linagliptin may be more beneficial.