1) Welcome to a tweetorial on GLP-1 RAs, CV outcomes, obesity mgt, & T2D! Accredited for 0.50h by @academiccme: physicians, nurses, pharmacists! I am @CMichaelGibson . . .
— cardio-met (@cardiomet_CE) May 11, 2021
2) Here’s a case. 47M dx’d T2D 4y ago by PCP. On metformin, statin, ACEi, ticgrelor. Last year had NSTEMI & 1 stent. Claims compliant with meds but not with meal plan, and now weighs 260 lbs; he feels most comfortable at 240. A1c is 9.5%. Has burning sensations feet and toes.
— cardio-met (@cardiomet_CE) May 11, 2021
4) Within 2 mo, pt had lost 5 lbs and sugars had stabilized. At 6-mo f/u, pt had lost 18 lbs, BMI had decreased by 4 kg/m2 with no change in activity level. Which of the following are potential benefits of GLP-1 RA therapy in this pt with T2D, obesity, & CAD?
— cardio-met (@cardiomet_CE) May 11, 2021
6) . . . is a diuretic/natriuretic, reduces BP, and reduces inflammation–all important for our pt with known CAD. His obesity doesn’t help that CAD either, limiting exercise tolerance and increasing inflammation.
— cardio-met (@cardiomet_CE) May 11, 2021
8) Mark your answer and return tomorrow for more on GLP-1 RAs! Nod to @ADocNamedDani @DBelardoMD @LarsSvenssonMD @lisajkuhn @josephahill @SAMITGHOSAL @angslycke @NavinKapur4 @VeroniqueRoger1 @ModerateFERN @preveaceo @fadwaf89 @DrVinodEndo @PharmacyUpdates #FOAMed
— cardio-met (@cardiomet_CE) May 11, 2021
10) The CAPTURE data further showed that fewer than one in four adults with T2D and established cardiovascular disease used a glucose-lowering agent with demonstrated cardiovascular benefits (SGLT2i, GLP-1 RA, DPP-4i). We have a huge treatment gap worldwide!
— cardio-met (@cardiomet_CE) May 12, 2021
12) This double-blind trial enrolled 1961 adults with BMI of GTE 30 who did NOT have DM to regulated lifestyle intervention (diet counseling, self-monitored calorie restriction, & ↑ing physical activity, with or without (2:1 ratio) weekly SQ injections of the GLP-RA semaglutide.
— cardio-met (@cardiomet_CE) May 12, 2021
14) Over 68 wks, mean change in BW from baseline was -14.9% in the semaglutide + lifestyle intervention group and -2.4% with lifestyle intervention alone. BW reduction of at least 5% occurred in 86.4% vs 31.5%, respectively. Both were significant to p < 0.001.
— cardio-met (@cardiomet_CE) May 12, 2021
16) . . . risk factors and a greater increase in patient-reported physical functioning/exercise tolerance. Nausea and diarrhea were more common in GLP-1 RA group but were generally transient, not severe, and self-limited. SAEs occurred in 9.8% of pts receiving semaglutide . .
— cardio-met (@cardiomet_CE) May 12, 2021
18) The authors noted specifically that the 14.9% mean weight loss with GLP-1 RA + lifestyle intervention is "substantially greater" than weight loss of 4-10.9% with approved antiobesity meds. And while this study excluded pts with DM, @AmDiabetesAssn guidelines focus on . .
— cardio-met (@cardiomet_CE) May 12, 2021
20) Beyond obesity, though, the CV benefits of GLP-1 RAs have been established. Guideline recommendations from the Task Force for the Diabetes, Pre-diabetes, and Cardiovascular Diseases of the @escardio and @easdelearning includes result from the five CV outcomes trials . . .
— cardio-met (@cardiomet_CE) May 12, 2021
22) . . . the #ESC/#EASD recommends liraglutide, semaglutide, or dulaglutide in patients with T2D and CVD or at very high/high CV risk to reduce the risk of cardiovascular events; and liraglutide, in these same patients, to reduce the risk of death.
— cardio-met (@cardiomet_CE) May 12, 2021
24) The 2020 ADA/EASD consensus report recommends the use of GLP-1 RAs throughout the treatment pathway in patients with T2D not controlled by metformin monotherapy as well as comprehensive lifestyle modifications . . .
— cardio-met (@cardiomet_CE) May 12, 2021
26) So there are guidelines recommendations supporting both GLP-1 RAs and SGLT2i's to improve metabolic and CV outcomes in patients with and without T2D. Do you think they could be combined for even greater effect?
— cardio-met (@cardiomet_CE) May 12, 2021
28) Welcome back to this accredited tweetorial on GLP-1 RAs. Follow this thread for credit–physicians, pharmacists, nurses! I am @CMichaelGibson. pic.twitter.com/DZXvqAZ87m
— cardio-met (@cardiomet_CE) May 13, 2021
30) The primary site of action for SGLT2 is the renal proximal tubule, while the GLP-1RAs stimulate insulin secretion through activation of GLP-1 receptors on the surface of pancreatic β cells and reduce glucagon secretion from pancreatic α cells.
— cardio-met (@cardiomet_CE) May 13, 2021
32) Post-hoc analysis showed the risk for MACE with combo exenatide plus an SGLT2i was numerically lower compared with both placebo (adjusted HR 0.68, 95% CI 0.39-1.17) and exenatide alone (0.85, 0.48-1.49). (Cardiovasc Diabetol. 2019;18(1):138. doi:10.1186/s12933-019-0942-x)
— cardio-met (@cardiomet_CE) May 13, 2021
34) . . . in blood sugar level, body weight and systolic blood pressure in older patients with T2D who are taking combined regimens of GLP-RA/SGLT2 inhibitor. The dropout and hypoglycemia rates were minimal . . .
— cardio-met (@cardiomet_CE) May 13, 2021
36) That's it! You made it! Free CE/#CME! Physicians, nurses, pharmacists: go to https://t.co/m9l641UOM6 and claim your credit! I am @CMichaelGibson. Follow @cardiomet_CE for more tweetorials! #Endotwitter #MedEd @ENDOUNO @endojorm
— cardio-met (@cardiomet_CE) May 13, 2021