The disclosure of proven cardiorenal benefits with certain antidiabetic agents was supposed to herald a new era in the management of type 2 diabetes (T2D), especially for the many patients with T2D who are at high risk for cardiovascular and renal events. However, as the evidence in favour of various sodium-glucose transporter-2 inhibitor (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1 RA) accumulates, prescriptions of these agents continue to stagnate, even among eligible, at-risk patients. By contrast, dipeptidyl peptidase-4 inhibitors (DPP-4i) DPP-4i remain more widely used than SGLT2i and GLP-1 RA in these patients, despite a similar cost to SGLT2i and a large body of evidence showing no clear benefit on cardiorenal outcomes. We are a group of diabetologists united by a shared concern that clinical inertia is preventing these patients from receiving life-saving treatments, as well as placing them at greater risk of hospitalisation for heart failure and progression of renal disease. We propose a manifesto for change, in order to increase uptake of SGLT2i and GLP-1 RA in appropriate patients as a matter of urgency, especially those who could be readily switched from an agent without proven cardiorenal benefit. Central to our manifesto is a shift from linear treatment algorithms based on HbA1c target setting to parallel, independent considerations of atherosclerotic cardiovascular disease, heart failure and renal risks, in accordance with newly updated guidelines. Finally, we call upon all colleagues to play their part in implementing our manifesto at a local level, ensuring that patients do not pay a heavy price for continued clinical inertia in T2D.

• MeSH
• biologické markery krev   MeSH
• celosvětové zdraví MeSH
• diabetes mellitus 2. typu krev   diagnóza   farmakoterapie   epidemiologie   MeSH
• glifloziny škodlivé účinky   terapeutické užití   MeSH
• hodnocení rizik MeSH
• inkretiny škodlivé účinky   terapeutické užití   MeSH
• kardiovaskulární nemoci diagnóza   epidemiologie   prevence a kontrola   MeSH
• klinické rozhodování MeSH
• krevní glukóza účinky léků   metabolismus   MeSH
• lékařská praxe - způsoby provádění MeSH
• lidé MeSH
• medicína založená na důkazech MeSH
• nemoci ledvin diagnóza   epidemiologie   prevence a kontrola   MeSH
• ochranné faktory MeSH
• receptor pro glukagonu podobný peptid 1 agonisté   MeSH
• regulace glykemie * škodlivé účinky   MeSH
• rizikové faktory MeSH
• směrnice pro lékařskou praxi jako téma MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH
• úvodníky MeSH

EMPA-REG OUTCOME is recognised by international guidelines as a landmark study that showed a significant cardioprotective benefit with empagliflozin in patients with type 2 diabetes (T2D) and cardiovascular disease. To assess the impact of empagliflozin in routine clinical practice, the ongoing EMPRISE study is collecting real-world evidence to compare effectiveness, safety and health economic outcomes between empagliflozin and DPP-4 inhibitors. A planned interim analysis of EMPRISE was recently published, confirming a substantial reduction in hospitalisation for heart failure with empagliflozin across a diverse patient population. In this commentary article, we discuss the new data in the context of current evidence and clinical guidelines, as clinicians experienced in managing cardiovascular risk in patients with T2D. We also look forward to what future insights EMPRISE may offer, as evidence is accumulated over the next years to complement the important findings of EMPA-REG OUTCOME.

• MeSH
• benzhydrylové sloučeniny škodlivé účinky   terapeutické užití   MeSH
• diabetes mellitus 2. typu diagnóza   farmakoterapie   mortalita   MeSH
• glifloziny škodlivé účinky   terapeutické užití   MeSH
• glukosidy škodlivé účinky   terapeutické užití   MeSH
• hodnocení rizik MeSH
• hospitalizace MeSH
• kardiovaskulární nemoci diagnóza   mortalita   terapie   MeSH
• klinické rozhodování MeSH
• klinické zkoušky jako téma metody   MeSH
• lékařská praxe - způsoby provádění MeSH
• lidé MeSH
• medicína založená na důkazech * MeSH
• ochranné faktory MeSH
• rizikové faktory MeSH
• směrnice pro lékařskou praxi jako téma MeSH
• výsledek terapie MeSH
• výzkumný projekt * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH