Navigating a Changing Landscape: ADA Standards Embrace CV, Renal Benefits of Newer Agents

Naomi Fisher, MD

Ahead of their annual scientific sessions, the American Diabetes Association (ADA) released updates to the Standards of Medical Care in Diabetes—2022 to further outline the potential for cardiovascular and renal protective benefits from newer agents.

With new research from phase 3 trials examining finerenone and SGLT2 inhibitors now included in the guidelines, clinicians have further backing for any decision to prescribe the agents for patients who may be at increased risk of adverse cardiovascular or renal outcomes. However, the data deemed worthy of inclusion in the document are from trials released nearly a year ago or longer and represent a growing recognition of the agents’ roles in preventing risk.

As such, the ADA’s amendment to include this data did not come as a surprise to those in the field. During an interview ahead of the ADA 82nd Scientific Sessions, Endocrinology Network asked Naomi Fisher, MD, director of Hypertension Service and Hypertension Specialty Clinic at Brigham and Women’s and associate professor in the division of Endocrinology, Diabetes and Hypertension at Harvard Medical School, to get her reaction to the move and how she thinks it may impact patients moving forward.

Endocrinology Network: What was your reaction to the ADA’s inclusion of finerenone and SGLT2 inhibitors in their Standards of Care, specifically the portions addressing management of cardiovascular and renal risk?

Fisher: It's been quite remarkable, both the rate at which we have new pharmacology and the rate at which adaption is being carried out. On very small scale, local levels, I see endocrinologists conversing with cardiologists. I see combined Grand Rounds. I see guidelines that are being jointly written. I see cardiologists reaching out to endocrinology colleagues and saying, "Well, I'm comfortable prescribing this, but maybe not this, and how am I going to help?"

So, it's really been really unprecedented. We have dramatic gains in cardiovascular benefit from drugs that were really developed in the world of diabetes that had been co-opted by cardiology. Now, we may find their primary role in cardiology or in nephrology is for the prevention of progression of kidney disease. Here, we have nondiabetologists who are in many institutions prescribing these drugs more than their counterparts in primary care.

So, you've hit upon a very, very real phenomenon. I would say the community is on it. There are lots of combined forces, combined guidelines, and, now, there's talk about combined fellowship programs where we're going to be training fellows who will have expertise in cardiovascular, endocrinology, and metabolic diseases to really have expertise in multiple areas because we're really starting to understand just how closely these are really intertwined.