Recommendations for the management of patients with type 2 diabetes at hospital discharge after an ischaemic cardiovascular event

IF 1.2 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Hipertension y Riesgo Vascular Pub Date : 2024-10-01 DOI:10.1016/j.hipert.2024.07.006

N.F. Renna , E.J. Zaidel , P. Corral , A.D. Lerner

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Abstract

The document outlines recommendations for the management of patients with type 2 diabetes (T2D) at hospital discharge following an ischaemic cardiovascular event. Diabetes significantly increases the risk of cardiovascular events, and a high proportion of patients in coronary units have this condition. The discharge process is crucial for optimising treatments and reducing the risk of recurrent complications such as reinfarction, stroke, and hospitalisations for heart failure.

Strategies include rigorous control of lipid levels, recommending potent statins combined with ezetimibe and, if necessary, other drugs such as inclisiran, evolocumab, alirocumab, or bempedoic acid. Optimal antihypertensive treatment is also suggested as secondary prevention.

For patients already on insulin, it is essential to adjust the dosage when adding SGLT-2 inhibitors (SGLT2i) or GLP-1 receptor agonists (GLP-1RA) to avoid hypoglycaemia, with structured glucose monitoring. In cases where HbA1c is not available during hospitalisation, the algorithm guides treatment, highlighting that GLP-1RA and SGLT2i do not cause hypoglycaemia. The combination of these drugs is safe and effective, improving several cardiovascular risk factors.

The document emphasises the importance of education on nutrition and healthy habits, as well as the follow-up and adjustment of pharmacological treatments to achieve adequate metabolic control and reduce cardiovascular risks. Nutritional evaluation and control are essential, considering obesity as a critical factor in T2D and its association with the risk of recurrent cardiovascular events.

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缺血性心血管事件后出院时对 2 型糖尿病患者的管理建议。

该文件概述了缺血性心血管事件后出院时对 2 型糖尿病 (T2D) 患者的管理建议。糖尿病会大大增加心血管事件的风险，冠心病病房的患者中有很大一部分患有糖尿病。出院过程对于优化治疗和降低再次发生并发症（如再梗塞、中风和心力衰竭住院）的风险至关重要。治疗策略包括严格控制血脂水平，建议使用强效他汀类药物联合依折麦布，必要时还可使用其他药物，如 inclisiran、evolocumab、alirocumab 或贝美度酸。作为二级预防，还建议进行最佳降压治疗。对于已经使用胰岛素的患者，在添加 SGLT-2 抑制剂（SGLT2i）或 GLP-1 受体激动剂（GLP-1RA）时，必须调整剂量以避免出现低血糖，并进行结构化血糖监测。在住院期间无法获得 HbA1c 的情况下，该算法可指导治疗，并强调 GLP-1RA 和 SGLT2i 不会导致低血糖。这些药物的联合使用安全有效，可改善多种心血管风险因素。文件强调了营养教育和健康习惯的重要性，以及药物治疗的随访和调整，以实现充分的代谢控制和降低心血管风险。考虑到肥胖是导致终末期糖尿病的关键因素，而且与复发性心血管事件的风险有关，因此营养评估和控制至关重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Hipertension y Riesgo Vascular Medicine-Internal Medicine

CiteScore

1.70

自引率

16.70%

发文量

审稿时长

39 days

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