DCRM Multispecialty Practice Recommendations for the management of diabetes, cardiorenal, and metabolic diseases

Yehuda Handelsman; John E Anderson; George L Bakris; Christie M Ballantyne; Joshua A Beckman; Deepak L Bhatt; Zachary T Bloomgarden; Biykem Bozkurt; Matthew J Budoff; Javed Butler; Samuel Dagogo-Jack; Ian H de Boer; Ralph A DeFronzo; Robert H Eckel; Daniel Einhorn; Vivian A Fonseca; Jennifer B Green; George Grunberger; Chris Guerin; Silvio E Inzucchi; Paul S Jellinger; Mikhail N Kosiborod; Pamela Kushner; Norman Lepor; Christian W Mende; Erin D Michos; Jorge Plutzky; Pam R Taub; Guillermo E Umpierrez; Muthiah Vaduganathan; Matthew R Weir

doi:10.1016/j.jdiacomp.2021.108101

DCRM Multispecialty Practice Recommendations for the management of diabetes, cardiorenal, and metabolic diseases

J Diabetes Complications. 2022 Feb;36(2):108101. doi: 10.1016/j.jdiacomp.2021.108101. Epub 2021 Dec 7.

Authors

Yehuda Handelsman¹, John E Anderson², George L Bakris³, Christie M Ballantyne⁴, Joshua A Beckman⁵, Deepak L Bhatt⁶, Zachary T Bloomgarden⁷, Biykem Bozkurt⁴, Matthew J Budoff⁸, Javed Butler⁹, Samuel Dagogo-Jack¹⁰, Ian H de Boer¹¹, Ralph A DeFronzo¹², Robert H Eckel¹³, Daniel Einhorn¹⁴, Vivian A Fonseca¹⁵, Jennifer B Green¹⁶, George Grunberger¹⁷, Chris Guerin¹⁸, Silvio E Inzucchi¹⁹, Paul S Jellinger²⁰, Mikhail N Kosiborod²¹, Pamela Kushner²², Norman Lepor⁸, Christian W Mende¹⁸, Erin D Michos²³, Jorge Plutzky⁶, Pam R Taub¹⁸, Guillermo E Umpierrez²⁴, Muthiah Vaduganathan⁶, Matthew R Weir²⁵

Affiliations

¹ Metabolic Institute of America, Tarzana, CA, USA. Electronic address: yhandelsman@gmail.com.
² The Frist Clinic, Nashville, TN, USA.
³ University of Chicago Medicine, Chicago, IL, USA.
⁴ Baylor College of Medicine, Houston, TX, USA.
⁵ Vanderbilt University Medical Center, Nashville, TN, USA.
⁶ Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
⁷ Mount Sinai School of Medicine, New York, NY, USA.
⁸ David Geffen School of Medicine, UCLA, Los Angeles, CA, USA.
⁹ University of Mississippi Medical Center, Jackson, MS, USA.
¹⁰ University of Tennessee Health Science Center, Memphis, TN, USA.
¹¹ University of Washington, Seattle, WA, USA.
¹² University of Texas Health Science Center, San Antonio, TX, USA.
¹³ University of Colorado Anschutz Medical Campus, Denver, CO, USA.
¹⁴ Scripps Whittier Institute for Diabetes, San Diego, CA, USA.
¹⁵ Tulane University Health Sciences Center, New Orleans, LA, USA.
¹⁶ Duke University Medical Center, Durham, NC, USA.
¹⁷ Grunberger Diabetes Institute, Bloomfield Hills, MI, USA, Wayne State University School of Medicine, Detroit, MI, USA, Oakland University William Beaumont School of Medicine, Rochester, MI, USA, Charles University, Prague, Czech Republic.
¹⁸ University of California San Diego School of Medicine, San Diego, CA, USA.
¹⁹ Yale School of Medicine, New Haven, CT, USA.
²⁰ The Center for Diabetes & Endocrine Care, University of Miami Miller School of Medicine, Hollywood, FL, USA.
²¹ Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, MO, USA.
²² University of California at Irvine, Irvine, CA, USA.
²³ Johns Hopkins University School of Medicine, Baltimore, MD, USA.
²⁴ Emory University, Atlanta, GA, USA.
²⁵ University of Maryland School of Medicine, Baltimore, MD, USA.

Abstract

Type 2 diabetes (T2D), chronic kidney disease (CKD), atherosclerotic cardiovascular disease (ASCVD), and heart failure (HF)-along with their associated risk factors-have overlapping etiologies, and two or more of these conditions frequently occur in the same patient. Many recent cardiovascular outcome trials (CVOTs) have demonstrated the benefits of agents originally developed to control T2D, ASCVD, or CKD risk factors, and these agents have transcended their primary indications to confer benefits across a range of conditions. This evolution in CVOT evidence calls for practice recommendations that are not constrained by a single discipline to help clinicians manage patients with complex conditions involving diabetes, cardiorenal, and/or metabolic (DCRM) diseases. The ultimate goal for these recommendations is to be comprehensive yet succinct and easy to follow by the nonexpert-whether a specialist or a primary care clinician. To meet this need, we formed a volunteer task force comprising leading cardiologists, nephrologists, endocrinologists, and primary care physicians to develop the DCRM Practice Recommendations, a multispecialty consensus on the comprehensive management of the patient with complicated metabolic disease. The task force recommendations are based on strong evidence and incorporate practical guidance that is clinically relevant and simple to implement, with the aim of improving outcomes in patients with DCRM. The recommendations are presented as 18 separate graphics covering lifestyle therapy, patient self-management education, technology for DCRM management, prediabetes, cognitive dysfunction, vaccinations, clinical tests, lipids, hypertension, anticoagulation and antiplatelet therapy, antihyperglycemic therapy, hypoglycemia, nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH), ASCVD, HF, CKD, and comorbid HF and CKD, as well as a graphical summary of medications used for DCRM.

Keywords: Atherosclerotic cardiovascular disease; Chronic kidney disease; Clinical practice; Consensus recommendations; Heart failure; Type 2 diabetes.

Publication types

Research Support, Non-U.S. Gov't
Review

MeSH terms

Cardiovascular Diseases* / complications
Cardiovascular Diseases* / epidemiology
Cardiovascular Diseases* / prevention & control
Cardiovascular System*
Diabetes Mellitus, Type 2* / complications
Diabetes Mellitus, Type 2* / epidemiology
Diabetes Mellitus, Type 2* / therapy
Humans
Hypoglycemic Agents / therapeutic use
Renal Insufficiency, Chronic* / complications
Renal Insufficiency, Chronic* / epidemiology
Renal Insufficiency, Chronic* / therapy

Substances

Hypoglycemic Agents

Grants and funding

R01 DK107239/DK/NIDDK NIH HHS/United States