Latin American Expert Consensus for Comprehensive Management of Type 2 Diabetes from a Metabolic–Cardio–Renal Perspective for the Primary Care Physician

Abstract

Growing scientific evidence from studies on type 2 diabetes (T2D) has recently led to a better understanding of the associated metabolic-cardio-renal risks. The large amount of available information makes it essential to have a practical guide that summarizes the recommendations for the initial management of patients with T2D, integrating different aspects of endocrinology, cardiology, and nephrology. The expert consensus presented here does not attempt to summarize all the evidence in this regard but rather attempts to define practical summary recommendations for the primary

Real‐world effectiveness and safety of insulin glargine 300 U/ml in insulin‐naïve people with type 2 diabetes in the Latin America region: A subgroup analysis of the ATOS

“…3,7,8 Previous reports from the Latin America region suggest that barriers to effective management of glycaemic control include a longer duration of diabetes, a complex regimen, limited knowledge and skills, therapeutic inertia, lack of drug adherence and inadequate access to healthcare resources. [8][9][10][11] Second-generation basal insulins such as insulin glargine 300 U/ml (Gla-300) have a more stable and prolonged duration of action with a favourable safety profile and may be a beneficial therapeutic option. 12 The effectiveness and safety of Gla-300 have been shown in randomized clinical trials (RCTs) [13][14][15][16][17][18][19] and real-world evidence (RWE) studies [20][21][22] that were mostly conducted in North America and Western Europe.…”

“… 3 , 7 , 8 Previous reports from the Latin America region suggest that barriers to effective management of glycaemic control include a longer duration of diabetes, a complex regimen, limited knowledge and skills, therapeutic inertia, lack of drug adherence and inadequate access to healthcare resources. 8 , 9 , 10 , 11 …”

“…Studies conducted in the Latin American people with T2D show that less than 55% achieve their glycaemic targets (HbA1c < 7% or fasting plasma glucose [FPG] < 126 mg/dl), despite receiving antidiabetic therapy 3,7,8 . Previous reports from the Latin America region suggest that barriers to effective management of glycaemic control include a longer duration of diabetes, a complex regimen, limited knowledge and skills, therapeutic inertia, lack of drug adherence and inadequate access to healthcare resources 8‐11 …”

The Cardiac Mineralocorticoid Receptor (MR): A Therapeutic Target Against Ventricular Arrhythmias

“…Nevertheless, the marked beneficial action of MR antagonism demonstrated in the treatment of cardiac failure, often in the absence of elevated aldosterone or sodium retention, strongly suggests that a similar therapeutic approach would be worth of investigation in the context of different pathophysiological situations, including cardiomyopathies associated with diabetes mellitus, Cushing syndrome, or reperfusion after ischemia. This assumption is somehow supported by the recent use of novel, selective non-steroidal MR antagonists, like finerenone ( 49 , 50 ), in the management of diabetic nephropathy and associated cardiovascular risk.…”

Metformin in cardiovascular diabetology: a focused review of its impact on endothelial function

“…Among COVID-19 patients with diabetes, the intensive care hospitalization rate and mortality rate are two to three times higher than that of patients without diabetes 286 . Diabetes has been identified as an independent risk factor for poor prognosis of COVID-19 287 , 288 . The underlying pathogenic links between COVID-19 and diabetes include effects on inflammation, glucose homeostasis, immune status changes and renin angiotensin aldosterone system (RAAS) activation 289 .…”