Building Competency in Diabetes Education THE ESSENTIALS

TREATMENT MODALITIES: PHARMACOLOGICAL THERAPIES I 6-19

The Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure ( DAPA-HF ) trial was the first trial of a SGLT2i to evaluate HF as a primary outcome in people with HF (reduced ejection fraction).

• Only 42% of participants had type 2 diabetes at baseline

Findings from DAPA-HF show dapagliflozin 10mg associated with: • 30% reduction in HHF • 18% reduction in CV death • 17% reduction in all-cause mortality

The Liraglutide Effect and Action in Diabetes: Evaluation of Cardiovascular Outcome Results ( LEADER ) trial also demonstrated superiority in CV events compared to placebo treatment (29,30). Population: • 81% had established CVD or stage 3 or higher CKD; 72% had CVD only • 28% primary prevention (CV risk factors only)

Treatment with liraglutide 1.8mg resulted in a: • 13% reduction in CV death, non-fatal MI or non-fatal stroke • 22% reduction in CV death • 15% reduction in all-cause mortality • NNT: 104 people for three years to prevent one CV death

The SUSTAIN-6 was a preapproval Trial to Evaluate Cardiovascular and Other Long-term Outcomes with Semaglutide in Subjects with Type 2 Diabetes. SUSTAIN-6 demonstrated superiority in CV events compared to placebo treatment (31). Population: • 83% had established CVD or stage 3 or higher CKD; 59% had CVD only • 41% primary prevention (CV risk factors only) • Eligibility criteria: o Type 2 diabetes with an A1C of ≥ 7% AND ≥ 50 y.o. with established CVD or stage 3 or higher CKD o ≥60 y.o. with at least 1 CV risk factor (microalbuminuria or proteinuria, hypertension and left ventricular hypertrophy, left ventricular systolic or diastolic dysfunction, or an ankle-brachial index of less than 0.9)

Treatment with semaglutide 0.5mg or 1.0mg s.c. resulted in a: