approccio al paziente diabetico con cardiopatia …con cardiopatia ischemica conflitti di interessi...
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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
Glycemic control in AMI
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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
Glycemic control in AMI
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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
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