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CardioDiabetes: Core Competencies for Cardiovascular Clinicians in a Rapidly Evolving Era of Type 2 Diabetes Management G. B. John Mancini, MD, Alice Y. Cheng, MD, Kim Connelly, MD, David Fitchett, MD, Ronald Goldenberg, MD, Shaun Goodman, MD, Lawrence A. Leiter, MD, Eva Lonn, MD, Breay Paty, MD, Paul Poirier, MD, PhD, James Stone, MD, PhD, David Thompson, MD, PhD, Subodh Verma, MD, PhD, Vincent Woo, MD, Jean-Francois Yale, MD Canadian Journal of Cardiology Volume 34, Issue 10, Pages (October 2018) DOI: /j.cjca Copyright © 2018 The Authors Terms and Conditions
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Figure 1 Summary of hazard ratios for events of interest as reported in recent trials showing either CV superiority or safety. Cells shaded in green indicate statistically significant results. *Although statistically significant, a superiority analysis was not pre-specified in this safety trial; #effects predominantly on albuminuria. CANVAS, CANagliflozin cardioVascular Assessment Study; CV, cardiovascular; EMPA-REG, Empagliflozin Cardiovascular Outcome Event Trial in T2D Patients (EMPA-REG OUTCOME); LEADER, Liraglutide Effect and Action in Diabetes: Evaluation of Cardiovascular Outcome Results; MACE, major adverse cardiac events (CV death, nonfatal MI, or stroke); MI, myocardial infarction; SUSTAIN-6, Trial to Evaluate Cardiovascular and Other Long-term Outcomes with Semaglutide in Subjects with Type 2 Diabetes. Canadian Journal of Cardiology , DOI: ( /j.cjca ) Copyright © 2018 The Authors Terms and Conditions
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Figure 2 Screening for type 2 diabetes in adults. If both fasting plasma glucose (FPG) and A1C are available but discordant, use the test that appears furthest to the right side of the algorithm. *Consider 75-g oral glucose tolerance test if there is an additional risk factor. **Consider 75-g oral glucose tolerance test. Reproduced from Ekoe et al.25 with permission from Elsevier. Canadian Journal of Cardiology , DOI: ( /j.cjca ) Copyright © 2018 The Authors Terms and Conditions
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Figure 3 Screening for type 2 diabetes in acute coronary syndromes (ACS). BG, blood glucose; CBG, capillary blood glucose; CBGM, CBG monitoring; PG, plasma glucose. Canadian Journal of Cardiology , DOI: ( /j.cjca ) Copyright © 2018 The Authors Terms and Conditions
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Figure 4 Simplified flow diagram for the selection of add-on antihyperglycemic agents. Semaglutide is shown in brackets because the superiority endpoint was not prespecified. CV, cardiovascular; DPP-4, dipeptidyl peptidase-4; GLP-1 RA, glucagon-like peptide-1 receptor agonists; SGLT2, sodium-glucose cotransporter-2; TZD, thiazolidinedione. Adapted from Lipscombe et al.50 with permission from Elsevier. Canadian Journal of Cardiology , DOI: ( /j.cjca ) Copyright © 2018 The Authors Terms and Conditions
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Figure 5 Short list of add-on antihyperglycemic agents showing CV superiority or safety. CV, cardiovascular; DPP-4, dipeptidyl peptidase-4; GLP-1, glucagon-like peptide-1; SGLT2, sodium-glucose cotransporter-2. Canadian Journal of Cardiology , DOI: ( /j.cjca ) Copyright © 2018 The Authors Terms and Conditions
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Figure 6 Key antihyperglycemic agents and renal function. CKD, chronic kidney disease; DPP-4, dipeptidyl peptidase-4; eGFR, estimated glomerular filtration rate; GLP-1, glucagon-like peptide-1; SGLT2, sodium-glucose cotransporter-2. Adapted from Lipscombe et al.50 with permission from Elsevier. Canadian Journal of Cardiology , DOI: ( /j.cjca ) Copyright © 2018 The Authors Terms and Conditions
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