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canagliflozin and renal outcomes in type 2 diabetes and nephropathy

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Hello my name is miyazano i’m going to talk about canogie flexing and regular accounts in titanfalls in our fat introductions tied to the various mellitus is the leading cause of king failure worldwide but few effectively long term treasons are available in cardiovascular trials of kilometers of sodium glucose construct water too explorative results have subjects

That such drugs may improve renal accounts in fashion weight tie to the page this trial is really important because diabetes and diabetic kidney disease are 21st century epidemics there are more than 400 million people with diabetes around the world at the moment and 40 of these people will get kidney disease once they’ve got kidney disease they’re at very

High risk of kidney failure of heart attack of stroke of heart failure and of death so with this trial we took a drug that’s available today for lowering blood sugar levels in people with diabetes but which we thought may well have additional special beneficial effects for the kidney and we gave it to people with diabetes who already had evidence of kidney damage

We took four thousand four hundred and one of these people from over thirty countries around the world and we gave half of them this drug canceflozen and the other half an identical placebo we found dramatic reductions in the risk of kidney failure and related outcomes in people with diabetes who were treated with this drug compared to those who just got a placebo

Not only did we reduce the risk of kidney failure but we also found that the risk of cardiovascular events like heart attack and stroke and heart failure were reduced dramatically as well these results are really important there are already more than 3 million people with kidney failure who need dialysis around the world today and that number’s projected to double

Over the next decade or two with this treatment because diabetes is the top cause of kidney failure in most countries we have the opportunity to prevent many of those people from ever reaching kidney failure i see so many patients who have had diabetes for some years and who start to develop signs of kidney failure until now we’ve for many of these people had to

Just watch them as they progressively developed kidney failure they suffered from the cardiovascular complications things like heart attack and stroke and ended up in many cases needing dialysis treatment just to keep them alive with this treatment for many of those people now we can offer them real hope and a better future applications in medicine development

Nutrition that can prevent or delay the progression of chronic kidney disease isglc2 are drugs that improve glycemic content in patients with the n2 at the moment they are marketed and factory flossing cannabis protein and the bagley flossing pros and cons brush produce a kidney disease and counts dead myocardial infarctions destruct hospitalization for her

Further now let’s move on to diabetes they were the declare results how do they fit in declare was an interesting study it looked at an sglt2 a drug that in part increases loss of glucose in your urine we think about these drugs to alter glucose levels controlling them better but in declare we found that in fact these could alter the ones likelihood of developing

Either heart failure or alternatively developing renal insufficiency kidney problems the drug was not effective in preventing development of atherosclerotic disease or coronary disease but for patients my perspective is if you tell a patient i can control your sugars better for a diabetic patient but i can also reduce your likelihood of developing heart failure

Or kidney disease to the things you worry most about that’s a win so does this mean we should also be thinking about treating heart failure or preventing heart failure and renal disease in type 2 diabetics yeah i think it’s exciting we have thought traditionally about diseases in one box or in one dimension we have drugs that lower glucose and we thought about

Them as diabetic treatments the realities are these drugs have multiple effects as we’re seeing and declare reducing one’s likelihood of developing heart failure improving one’s kidney function as a function of time or not preventing worsening of kidney function so i think we’re thinking about now these drugs how we’re treating a whole diabetic patient not

Only their control of their glucose but looking at how it might affect their heart as well as their kidneys that’s great issues negro at the time four thousand four hundred and once russian had undergone randomizations with a medium formula of 2.62 years the relative risk of the primary occurrence was 30 percent lower in the cannabis plastic drops that in the

Plasterboard group with event rate of 40.2 and 61.2 per 1000 passengers respectively the relative risks of the renault specific compositive of anesthetics kidney disease a doubling of the creatinine level or that from renal causes was lowered by 34 percent and the relative rates of the anesthetic kidney disease was lower by 32 percent conclusions impressions

We tied to the various and kidney disease the roots of the kidney fireworks and cardiovascular events was lower in the cannabinoid forcing group dug in the plaster groups at the median follow-up of 2.62 years so i mean the canvas trial was set up to test the safety and efficacy of canical flows in diabetes and the main manuscript itself was actually published

Six months ago what they described there was was an important benefit in diabetics on three-point cardiovascular mace but importantly there seemed to be a real benefit in one of the secondary endpoints which is heart failure and really this is consistent with what’s being seen with some of the other sglt2 inhibitors and it’s really exciting from a cardiovascular

Perspective and a cardiologist or a clinician’s perspective because diabetes heart failure is one of the biggest problems for diabetes that despite having good glucose lowering management we’ve not been able to previously see benefits on in terms of the heart failure effects so we then set out to really try and understand what was happening in terms of the heart

Failure events in this large randomized trial and what we particularly were interested in is if they had a diagnosis of heart failure at baseline did they still receive the same benefit and the same safety um and what we did see is obviously the high we confirmed that you do see a very high level of events in people who’ve got heart failure at baseline and so

By the end of the study 25 of them had actually had a heart failure event um and that was dramatically reduced by the stlt2 inhibitors we saw a a borderline significant interaction between having a diagnosis of heart failure at baseline and the benefits suggesting potentially higher benefits in patients that had heart failure at baseline well look there’s a lot

Of interest in this area because of its huge implications worldwide obviously the burden of disease is there and what’s being now run is obviously prospective trials looking particularly at the benefits of sdlt2 inhibitors in patients with heart failure specifically and so i think this will be something that will you know rapidly be changing practice well i

Think um obviously trying to understand whether the slt-2 inhibitors actually work in different classes of heart failure one area that we really struggle as physicians to look after and change outcomes in is people with heart failure but preserved ejection fraction a very hot topic will be whether or not this class of agents may be one of the first to actually

Make a difference in that particular area so i know these studies are actually being carried out at the moment certainly um from a cardiologist’s perspective i think we are now at a point where we need to engage much better with our endocrinology colleagues and actually learn about when we should be initiating some of this treatment and how we can partner with

Them to improve the outcomes of our patients

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canagliflozin and renal outcomes in type 2 diabetes and nephropathy By Miguel CedeƱo