0742ba2480a425ff660e7863fa7e2b7c 301682.pdf 6881962631a0e87ee35e1569ff65fc8c2ed711fe 301682.pdf 05a0d62592426dad88bc493ab5323348d60488948c1ccc0eaaf5b32b00477627 301682.pdf Title: Comprehensive Cardiovascular and Renal Protection in Patients with Type 2 Diabetes Subject: Type 2 diabetes (T2DM) is one of the main public health care problems worldwide. It is associated with a marked increased risk of developing atherosclerotic vascular disease, heart failure, chronic kidney disease and death. It is essential to act during the early phases of the disease, through the intensification of lifestyle changes and the prescription of those drugs that have been shown to reduce these complications, with the aim not only of achieving an adequate metabolic control, but also a comprehensive vascular risk control. In this consensus document, developed by the different specialists that treat these patients (endocrinologists, primary care physicians, internists, nephrologists and cardiologists), a more appropriate approach in the management of patients with T2DM or its complications is provided. A particular focus is given to the global control of cardiovascular risk factors, the inclusion of weight within the therapeutic objectives, the education of patients, the deprescription of those drugs without cardiovascular benefit, and the inclusion of GLP-1 receptor agonists and SGLT2 inhibitors as cardiovascular protective drugs, at the same level as statins, acetylsalicylic acid, or renin angiotensin system inhibitors. Keywords: diabetes; cardiovascular; GLP-1 receptor agonists; glycated hemoglobin; renal; SGLT2 inhibitors Author: Almudena Castro Conde, Domingo Marzal Martín, Raquel Campuzano Ruiz, Maria Rosa Fernández Olmo, Carlos Morillas Ariño, Juan José Gómez Doblas, Jose Luis Gorriz Teruel, Pilar Mazón Ramos, Xavier García-Moll Marimon, Maria Jose Soler Romeo, David León Jiménez, Vicente Arrarte Esteban, Juan Carlos Obaya Rebollar, Carlos Escobar Cervantes and Juan J. Gorgojo Martínez Creator: LaTeX with hyperref Producer: pdfTeX-1.40.21 CreationDate: Thu Jun 8 10:33:06 2023 CEST ModDate: Thu Jun 8 11:11:53 2023 CEST Custom Metadata: no Metadata Stream: no Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 37 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 1152647 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- LMAKNS+VnURWPalladioL Type 1 Custom yes yes no 10 0 ZELOCH+URWPalladioL-Bold Type 1 Custom yes yes no 15 0 NELIZE+URWPalladioL-Roma Type 1 Custom yes yes no 20 0 OBDSBF+URWPalladioL-Ital Type 1 Custom yes yes no 24 0 JYPLJJ+VnURWPalladioL-Bold Type 1 Custom yes yes no 28 0 XPUSBJ+TimesNewRomanPS-BoldItalicMT Type 1C WinAnsi yes yes no 46 0 BSDWLC+TimesNewRomanPSMT Type 1C WinAnsi yes yes no 49 0 UEBRAH+CMSY10 Type 1 Builtin yes yes no 74 0 IOLAWT+PazoMath-Italic Type 1 Builtin yes yes no 90 0 CKBPVA+EURM10 Type 1 Builtin yes yes no 94 0 FDCMNH+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 106 0 FDCMNJ+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 109 0 FDCMOK+PalatinoLinotype CID TrueType Identity-H yes yes yes 112 0 FDCMOL+PalatinoLinotype TrueType WinAnsi yes yes no 118 0 FDCMOM+PalatinoLinotype TrueType MacRoman yes yes no 121 0 FDCMPM+Cambria CID TrueType Identity-H yes yes yes 124 0 GFLAOE+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 163 0 GFLAOG+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 166 0 GFLAPH+PalatinoLinotype CID TrueType Identity-H yes yes yes 169 0 GFLAPI+PalatinoLinotype TrueType WinAnsi yes yes no 175 0 GFLBCI+PalatinoLinotype TrueType MacRoman yes yes no 178 0 GFLBDI+Cambria CID TrueType Identity-H yes yes yes 181 0 GFLBDJ+Cambria,Bold CID TrueType Identity-H yes yes yes 187 0 BCDEEE+PalatinoLinotype-Bold TrueType WinAnsi yes yes no 210 0 BCDFEE+PalatinoLinotype-Roman TrueType WinAnsi yes yes no 214 0 BCDGEE+PalatinoLinotype-Italic TrueType WinAnsi yes yes no 218 0 BCDIEE+PalatinoLinotype-Roman CID TrueType Identity-H yes yes yes 222 0 BCDJEE+PalatinoLinotype-Bold CID TrueType Identity-H yes yes yes 229 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2024-10-17 02:41:46 CEST RepresentationInformation: 301682.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2024-10-16 11:09:54 CEST Size: 1152647 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 799 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: section.1 Item: Title: Multifactorial Approach to Reduce the Vascular-Renal Risk Destination: section.2 Children: Item: Title: Weight Destination: subsection.2.1 Item: Title: Physical Activity Destination: subsection.2.2 Item: Title: Smoking Destination: subsection.2.3 Item: Title: Lipids Destination: subsection.2.4 Item: Title: Blood Pressure Destination: subsection.2.5 Item: Title: Glycated Hemoglobin Destination: subsection.2.6 Item: Title: Cognitive Impairment Destination: subsection.2.7 Item: Title: Antihyperglycemic Drugs Destination: section.3 Children: Item: Title: Biguanides (Metformin) Destination: subsection.3.1 Item: Title: Sulfonylureas Destination: subsection.3.2 Item: Title: Glinides Destination: subsection.3.3 Item: Title: -Glucosidase Inhibitors Destination: subsection.3.4 Item: Title: Thiazolidinediones or Glitazones Destination: subsection.3.5 Item: Title: Inhibitors of the Enzyme Dipeptidyl Peptidase Type 4 Destination: subsection.3.6 Item: Title: Sodium-Glucose Cotransporter Type 2 Inhibitors Destination: subsection.3.7 Item: Title: Glucagon-Like Peptide 1 Receptor Agonists Destination: subsection.3.8 Item: Title: Insulin Destination: subsection.3.9 Item: Title: Metabolic Surgery Destination: section.4 Item: Title: Diabetes and CKD. Importance of Estimating Renal Function and Albuminuria in Patients with T2DM Destination: section.5 Children: Item: Title: Assessment of Renal Involvement: How? Destination: subsection.5.1 Item: Title: What Type of Equation Should Be Use to Estimate GFR? Destination: subsection.5.2 Item: Title: Which Is the Best Sample to Estimate Albuminuria? Destination: subsection.5.3 Item: Title: How Often Should Renal Function Be Estimated in Patients with T2DM? Destination: subsection.5.4 Item: Title: Drugs of Choice in Patients with Diabetes and CKD Destination: subsection.5.5 Item: Title: Treatment Proposal Destination: section.6 Children: Item: Title: Definition of Metabolic Control Destination: subsection.6.1 Children: Item: Title: Recommendation Destination: subsubsection.6.1.1 Item: Title: Support of the Recommendation Destination: subsubsection.6.1.2 Item: Title: Explanation of Optimization of Metabolic Control Destination: subsection.6.2 Children: Item: Title: Recommendation Destination: subsubsection.6.2.1 Item: Title: Support of the Recommendation Destination: subsubsection.6.2.2 Item: Title: Explanation of De-Intensification Destination: subsection.6.3 Children: Item: Title: Recommendation Destination: subsubsection.6.3.1 Item: Title: Support of the Recommendation Destination: subsubsection.6.3.2 Item: Title: Explanation of the Choice of Drugs in Patients with eGFR < 15 mL/min Destination: subsection.6.4 Children: Item: Title: Explanation of Choice of GLP-1 Receptor Agonists Destination: subsubsection.6.4.1 Item: Title: Explanation of Choice of Insulin Destination: subsection.6.5 Children: Item: Title: Recommendation Destination: subsubsection.6.5.1 Item: Title: Support of the Recommendation Destination: subsubsection.6.5.2 Item: Title: Explanation of the Indication for Bariatric/Metabolic Surgery Destination: subsection.6.6 Children: Item: Title: Recommendation Destination: subsubsection.6.6.1 Item: Title: Support of the Recommendation Destination: subsubsection.6.6.2 Item: Title: Conclusions Destination: section.7 Item: Title: References Destination: section.8 Info: Title: Comprehensive Cardiovascular and Renal Protection in Patients with Type 2 Diabetes Author: Almudena Castro Conde, Domingo Marzal Martín, Raquel Campuzano Ruiz, Maria Rosa Fernández Olmo, Carlos Morillas Ariño, Juan José Gómez Doblas, Jose Luis Gorriz Teruel, Pilar Mazón Ramos, Xavier García-Moll Marimon, Maria Jose Soler Romeo, David León Jiménez, Vicente Arrarte Esteban, Juan Carlos Obaya Rebollar, Carlos Escobar Cervantes and Juan J. Gorgojo Martínez Subject: Type 2 diabetes (T2DM) is one of the main public health care problems worldwide. It is associated with a marked increased risk of developing atherosclerotic vascular disease, heart failure, chronic kidney disease and death. It is essential to act during the early phases of the disease, through the intensification of lifestyle changes and the prescription of those drugs that have been shown to reduce these complications, with the aim not only of achieving an adequate metabolic control, but also a comprehensive vascular risk control. In this consensus document, developed by the different specialists that treat these patients (endocrinologists, primary care physicians, internists, nephrologists and cardiologists), a more appropriate approach in the management of patients with T2DM or its complications is provided. A particular focus is given to the global control of cardiovascular risk factors, the inclusion of weight within the therapeutic objectives, the education of patients, the deprescription of those drugs without cardiovascular benefit, and the inclusion of GLP-1 receptor agonists and SGLT2 inhibitors as cardiovascular protective drugs, at the same level as statins, acetylsalicylic acid, or renin angiotensin system inhibitors. 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