Approccio al paziente diabetico con cardiopatia …con cardiopatia ischemica Conflitti di interessi...

Edoardo Mannucci

Approccio al paziente diabetico con cardiopatia ischemica

Conflitti di interessi

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Negli ultimi due anni, E. Mannucci ha ricevuto: compensi per consulenze da AstraZeneca, Boehringer Ingelheim, Eli Lilly, Merck, Mundipharma e Novo Nordiskcompensi per relazioni a corsi/convegni da Abbott e Eli Lillycompensi da agenzie in simposi sponsorizzati da Abbott, Allergan, AstraZeneca, Boehringer Ingelheim, Bruno, Eli Lilly, Menarini, Merck, Mundipharma, Novo Nordisk, Sanofi e Takeda

La struttura diretta da E. Mannucci ha ricevuto:finanziamenti per attività di ricerca e/o educative da AstraZeneca, Bayer, BoehringerIngelheim, Molteni e Novo Nordiskcompensi per trial clinici da:AstraZeneca, Eli Lilly, Genentech, Janssen, Novartis e Novo Nordisk.

Glycemic control in AMI

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Malmberg K et al. Eur Heart J 17:1337-44,1996

RCT, intensified insulin treatment vs conventional treatment of hyperglycemia, from admission to end of follow-up (3 years)

Patients: subjects with DM, randomized at admission for AMI

1-year results of the DIGAMI trial

Glycemic control and survival in ICU

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Van den Berghe G et al. N Engl J Med 354:449-61, 2006

RCT:1200 patients with diabetes or stress hyperglycemia

Intensified insulin treatment vs conventional treatment of hyperglycemia

Glycemic control and survival in after ACS

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NICE-SUGAR Investigators. N Engl J Med 360:1283-97, 2009

Intensified insulin treatment vs conventional treatment of hyperglycemia

Insulin and AMI

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Puskarich MA et al. J Clin Pharmacol. 49:758-67, 2009

Meta-analysis of RCTs on GIK infusion

Trials performed on patients withoutdiabetes or relevant stress hyperglycemia (in whom GIK didnot produce a relevant reduction of blood glucose levels)

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Insulina ev per il paziente in nutrizione parenterale: protocollo di Yale

AMD-SID, 2016

Glycemic control and risk of MI in T2DM

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Mannucci E et al. Nutr Metab Cardiovasc Dis 19: 604-12, 2009

Meta-analysis of RCTs on intensification of therapy


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Malmberg K et al. Eur Heart J 26:650-661, 2005

RCT in subjects with DM, randomized at admission for AMI:

Group 1: IIT+IITGroup 2: IIT+CTGroup 3: CT+CT

IIT: intensified insulin treatmentCT: conventional therapy

Results of the DIGAMI-2 trial


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Malmberg K et al. Eur Heart J 26:650-661, 2005

RCT in subjects with DM, randomized at admission for AMI:

Group 1: IIT+IITGroup 2: IIT+CTGroup 3: CT+CT

IIT: intensified insulin treatmentCT: conventional therapy

Results of the DIGAMI-2 trial

Cardiovascular risk with insulin therapy in T2DM

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Mannucci E, Ferrannini E. Diabetes Obes Metab 19:1201-1204, 2017.

Observational studies vs RCT

Glargine insulin: effect on major cardiovascular events

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ORIGIN trial investigators. N Engl J Med 367:319-28, 2012

Results of the ORIGIN trial

GLP-1 RA: effects on MACE and all-cause mortality

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Mannucci E et al. Diabetes Obes Metab 2019

A meta-analysis of RCTs with CV endpoint

GLP-1 RA: effects on MACE

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Mannucci E et al. Diabetes Obes Metab 2019

A meta-analysis of RCTs with CV endpoint

SGLT-2i: effects on MACE

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Zelniker TA et al. Lancet 393: 31–39, 2019

A meta-analysis of CVOTs

ESC-EASD Guidelines on type 2 diabetes, 2019

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Cosentino F et al. Eur Heart J 2019

Metformin and cardiovascular events

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UKPDS 33. Lancet 352:854-65, 1998

Results of the UKPDS trial

Metformin and MACE

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Kooy A et al. Ann Intern Med 169:616-25, 2009

RCT, metformin vs placebo

Patients: 390 outpatients with T2DM on insulin therapy

Results of a 4.3-y placebo-controlled RCT

hazard ratio:0.61 (95% CI, 0.40-0.94; P=.02)

NNT: 16

Metformin and cardiovascular events

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Lamanna C et al. Diabetes Obes Metab 13: 221–228, 2011

Meta-analysis of available RCTs

SGLT2 inihibitors and MACE: effect of baseline risk

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Mannucci E et al. Nutr Metab Cardiovasc Dis [in press]

Metaregression of results of CVOT

Pioglitazone: effect on major cardiovascular events

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Dormandy J et al. Lancet 366: 1279-89, 2005

Results of the PROACTIVE trial

Pioglitazone and heart failure

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Dormandy et al. Lancet 366:1279-89, 2005

Results of the PROACTIVE trial

Standard italiani per la cura del diabete mellitoEdizione 2018

ESC-EASD Guidelines on type 2 diabetes, 2019

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Cosentino F et al. Eur Heart J 2019

Approccio al paziente diabetico con cardiopatia …con cardiopatia ischemica Conflitti di interessi...

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