From Clinical Trial Evidence to Clinical Guidelines: Perspectives on REWIND from Clinicians in the Gulf and Levant Region
Background: Current guidelines recommend that glucagon-like peptide-1 receptor agonists (GLP-1 RAs) with proven cardiovascular benefit should be considered for first-line therapy in patients with type 2 diabetes (T2D) who have/are at high risk of atherosclerotic cardiovascular disease (CVD). Summary...
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| Format: | Article |
| Language: | English |
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Karger Publishers
2023-11-01
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| Series: | Dubai Diabetes and Endocrinology Journal |
| Subjects: | |
| Online Access: | https://beta.karger.com/Article/FullText/534713 |
| _version_ | 1797391584862404608 |
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| author | Talal Ashour Sami Azar Akram Echtay Muhammad Farooqi Tarek Fiad Mohamed Hassanein Ahmed Hassoun Abdul Jabbar Amin Jayyousi Kari Ranta Hani Sabbour Fatih Tangi Ibrahim Turfanda |
| author_facet | Talal Ashour Sami Azar Akram Echtay Muhammad Farooqi Tarek Fiad Mohamed Hassanein Ahmed Hassoun Abdul Jabbar Amin Jayyousi Kari Ranta Hani Sabbour Fatih Tangi Ibrahim Turfanda |
| author_sort | Talal Ashour |
| collection | DOAJ |
| description | Background: Current guidelines recommend that glucagon-like peptide-1 receptor agonists (GLP-1 RAs) with proven cardiovascular benefit should be considered for first-line therapy in patients with type 2 diabetes (T2D) who have/are at high risk of atherosclerotic cardiovascular disease (CVD). Summary: Only one GLP-1 RA – dulaglutide – has demonstrated superiority versus placebo in reducing cardiovascular risk in patients with T2D with or without a history of CVD in a cardiovascular outcomes trial (CVOT). This trial – REWIND – is the only GLP-1 RA-based CVOT that recruited patients with a CVD prevalence (31%) that is similar to the estimated prevalence in primary care T2D populations in the Gulf and Levant region. In contrast, baseline CVD prevalence in all other GLP-1 RA-based CVOTs ranged from 73 to 100%. REWIND’s results provided the European Association for the Study of Diabetes and American Diabetes Association with data on which to base updated guidelines. These organisations subsequently recommended that GLP-1 RAs should be considered for primary CVD prevention in high cardiovascular-risk patients with T2D, and acknowledged that present evidence supporting GLP-1 RAs for primary prevention of CVD in T2D is strongest for dulaglutide but limited for other GLP-1 RAs. The Emirates Diabetes Society guidelines also support the use of GLP-1 RAs for primary cardiovascular prevention in patients with T2D. The cardiovascular benefit conferred by dulaglutide in patients with no CVD history, and the close alignment of the REWIND cohort with patient populations in the Gulf and Levant region, may better inform physicians in the early use of dulaglutide in patients with T2D and multiple cardiovascular-risk factors, regardless of CVD history. Utilizing published data and author opinion, this review explores the importance of taking a cardiocentric approach to T2D management, and discusses the clinical implications of REWIND for people with T2D in the Gulf and Levant region. Key Messages: Guideline recommendations, including those of the Emirates Diabetes Society, state that GLP-1 RAs with proven cardiovascular benefit should be considered for primary CVD prevention in high cardiovascular-risk patients with T2D. This recommendation was informed, in part, by REWIND; REWIND was the only CVOT to show that a GLP-1 RA (dulaglutide) reduces cardiovascular risk in patients with T2D with or without established CVD. Demonstration of cardiovascular benefit in the REWIND cohort, which aligns closely with patient populations in the Gulf and Levant region, may better inform physicians in the early use of dulaglutide in patients with T2D, regardless of CVD history. |
| first_indexed | 2024-03-08T23:35:00Z |
| format | Article |
| id | doaj.art-716fdb93783548ef97d665013e406f57 |
| institution | Directory Open Access Journal |
| issn | 2673-1738 |
| language | English |
| last_indexed | 2024-03-08T23:35:00Z |
| publishDate | 2023-11-01 |
| publisher | Karger Publishers |
| record_format | Article |
| series | Dubai Diabetes and Endocrinology Journal |
| spelling | doaj.art-716fdb93783548ef97d665013e406f572023-12-14T07:52:12ZengKarger PublishersDubai Diabetes and Endocrinology Journal2673-17382023-11-0111110.1159/000534713534713From Clinical Trial Evidence to Clinical Guidelines: Perspectives on REWIND from Clinicians in the Gulf and Levant RegionTalal Ashour0Sami Azar1Akram Echtay2Muhammad Farooqi3Tarek Fiad4Mohamed Hassanein5Ahmed Hassoun6Abdul Jabbar7Amin Jayyousi8Kari Ranta9Hani Sabbour10Fatih Tangi11Ibrahim Turfanda12Al Seef Hospital, Salmiya, KuwaitDivision of Endocrinology, Diabetes and Metabolism, University of Balamand, Beirut, LebanonRafik Hariri University Hospital, Beirut, LebanonDubai Diabetes Center, Dubai, United Arab EmiratesCenter for Diabetes and Endocrinology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab EmiratesDubai Hospital, Dubai Health Authority, Dubai, United Arab EmiratesFakeeh University Hospital, Dubai, United Arab EmiratesMedcare Hospital, Dubai, United Arab EmiratesHamad Medical Corporation, Doha, QatarEli Lilly, Helsinki, FinlandHeart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab EmiratesEli Lilly, Dubai, United Arab EmiratesEli Lilly, Dubai, United Arab EmiratesBackground: Current guidelines recommend that glucagon-like peptide-1 receptor agonists (GLP-1 RAs) with proven cardiovascular benefit should be considered for first-line therapy in patients with type 2 diabetes (T2D) who have/are at high risk of atherosclerotic cardiovascular disease (CVD). Summary: Only one GLP-1 RA – dulaglutide – has demonstrated superiority versus placebo in reducing cardiovascular risk in patients with T2D with or without a history of CVD in a cardiovascular outcomes trial (CVOT). This trial – REWIND – is the only GLP-1 RA-based CVOT that recruited patients with a CVD prevalence (31%) that is similar to the estimated prevalence in primary care T2D populations in the Gulf and Levant region. In contrast, baseline CVD prevalence in all other GLP-1 RA-based CVOTs ranged from 73 to 100%. REWIND’s results provided the European Association for the Study of Diabetes and American Diabetes Association with data on which to base updated guidelines. These organisations subsequently recommended that GLP-1 RAs should be considered for primary CVD prevention in high cardiovascular-risk patients with T2D, and acknowledged that present evidence supporting GLP-1 RAs for primary prevention of CVD in T2D is strongest for dulaglutide but limited for other GLP-1 RAs. The Emirates Diabetes Society guidelines also support the use of GLP-1 RAs for primary cardiovascular prevention in patients with T2D. The cardiovascular benefit conferred by dulaglutide in patients with no CVD history, and the close alignment of the REWIND cohort with patient populations in the Gulf and Levant region, may better inform physicians in the early use of dulaglutide in patients with T2D and multiple cardiovascular-risk factors, regardless of CVD history. Utilizing published data and author opinion, this review explores the importance of taking a cardiocentric approach to T2D management, and discusses the clinical implications of REWIND for people with T2D in the Gulf and Levant region. Key Messages: Guideline recommendations, including those of the Emirates Diabetes Society, state that GLP-1 RAs with proven cardiovascular benefit should be considered for primary CVD prevention in high cardiovascular-risk patients with T2D. This recommendation was informed, in part, by REWIND; REWIND was the only CVOT to show that a GLP-1 RA (dulaglutide) reduces cardiovascular risk in patients with T2D with or without established CVD. Demonstration of cardiovascular benefit in the REWIND cohort, which aligns closely with patient populations in the Gulf and Levant region, may better inform physicians in the early use of dulaglutide in patients with T2D, regardless of CVD history.https://beta.karger.com/Article/FullText/534713cardiovascular outcomes trialscardiovascular riskdulaglutideglucagon-like peptide-1 receptor agonistsgulf and levantprimary preventionrewind |
| spellingShingle | Talal Ashour Sami Azar Akram Echtay Muhammad Farooqi Tarek Fiad Mohamed Hassanein Ahmed Hassoun Abdul Jabbar Amin Jayyousi Kari Ranta Hani Sabbour Fatih Tangi Ibrahim Turfanda From Clinical Trial Evidence to Clinical Guidelines: Perspectives on REWIND from Clinicians in the Gulf and Levant Region Dubai Diabetes and Endocrinology Journal cardiovascular outcomes trials cardiovascular risk dulaglutide glucagon-like peptide-1 receptor agonists gulf and levant primary prevention rewind |
| title | From Clinical Trial Evidence to Clinical Guidelines: Perspectives on REWIND from Clinicians in the Gulf and Levant Region |
| title_full | From Clinical Trial Evidence to Clinical Guidelines: Perspectives on REWIND from Clinicians in the Gulf and Levant Region |
| title_fullStr | From Clinical Trial Evidence to Clinical Guidelines: Perspectives on REWIND from Clinicians in the Gulf and Levant Region |
| title_full_unstemmed | From Clinical Trial Evidence to Clinical Guidelines: Perspectives on REWIND from Clinicians in the Gulf and Levant Region |
| title_short | From Clinical Trial Evidence to Clinical Guidelines: Perspectives on REWIND from Clinicians in the Gulf and Levant Region |
| title_sort | from clinical trial evidence to clinical guidelines perspectives on rewind from clinicians in the gulf and levant region |
| topic | cardiovascular outcomes trials cardiovascular risk dulaglutide glucagon-like peptide-1 receptor agonists gulf and levant primary prevention rewind |
| url | https://beta.karger.com/Article/FullText/534713 |
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