Heart & Diabetes Conference: Target The Octet To Treat Right

Corresponding Author: Dr. Rishad Ahmed, Associate Professor, Department of Medicine, KPC Medical College & Hospital , Kolkata, West Bengal 700032, India

Biography : Dr Rishad Ahmed has special interest in Diabetes & Metabolic disorders. He completed his MD in Internal Medicine from the prestigious Rajiv Gandhi University of Health Sciences , then Diploma and Fellowship in Diabetes with distinction, a biographee in Who’s Who in Medicine & Healthcare & also accepted as boigraphee in Who’s Who of World 2018, a passionate teacher with several national & international publications Member : Association of Physicians in India, American Diabetes Association & Endocrine Society, US.

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The ominous octet is the pathophysiological core in the mechanism of diabetes. Every molecule has there different reference targets & and these targets are individually targeted at different times in the entire course & duration of diabetes. Metformin is an absolute necessity for treating diabetes if there are no contraindications. Newer class of drugs like SGLT2I & DPP4i have strengthened our treat-to-target goal for individual diabetic patients. As evident we know that reaching desired HbA1c goals is very difficult and we have to tailor our treatment protocols as per individual cases. We do not know which pathological pathway is affecting the individual and contributing to the diabetic status. SGLT2i target kidneys and DPP4i target the gut hormones in two different mechanisms all together. Its debatable which one may be used first but clearly if one goes by evidence & recommendations, diabetic with a background of cardiovascular disease must be initiated with an oral empagliflozin(SGLT2i) which is also approved by USFDA now. Why we are interested in diabetes and CVD is a well known and very important concept of the two to threefold increased risk of cardiovascular disease & cardiovascular death in patients with diabetes. Now we also know that almost three fourths of the patients with diabetes has minimal CAD when screened. Hence the burden of cardiovascular disease & death is so high in diabetes that the first choice should always be a SGLT2i over a DPP4i. Now DPP4i has its own advantages and compliment effects of SGLT2i in many different ways. Both have different target organs. It is known that whereas SGLT2i are known to increase the glucagon levels in blood, DPP4i are known to suppress glucagon levels by acting on the alfa cells, hence they complement each other well. The combination of SGLT2i/DPP4i not only complement each other well, this combination targets a lot of components in the ominous octet. Almost five components by DPP4i & two by SGLT2i. They are also known to halt the progression of chronic kidney disease by decreasing progression of albuminuria. Hence after metformin or even before using metformin this combination may give good treat-to-target benefits to the patients. Hence use SGLT2i/DPP4i combination in suitable patients. So using this combination will TREAT EARLY & TREAT HARD.