Invokana Guidelines for T2DM

Kidney, heart and blood drop icon image
 

Invokana Guidelines for T2DM

Guideline Recommendations

ADA/EASD consensus report

CKD or HF
  • For patients with T2DM where Chronic Kidney Disease (CKD) or Heart Failure (HF) predominates, an SGLT2i* shown to reduce CKD and/or HF progression in CVOTs if eGFR is adequate, is preferable1
  • If SGLT2i not tolerated or contraindicated or if eGFR less than adequate** add GLP-1 RA with proven CVD benefit***1
ASCVD
  • For patients with T2DM where atherosclerotic cardiovascular disease (ASCVD) predominates, a GLP-1 RA with proven CVD benefit is preferable***1
  • Or an SGLT2i with proven CVD benefit*** if eGFR is adequate**1

*Empagliflozin, canagliflozin and dapagliflozin have shown reduction in HF and to reduce CKD progression in CVOTs. Canagliflozin has primary renal outcome data from CREDENCE. Dapagliflozin has primary heart failure outcome data from DAPA-HF.

**Be aware that SGLT2i labelling varies by region and individual agent with regard to indicated level of eGFR for initiation and continued use.

***Proven CVD benefit means it has label indication of reducing CVD events.

Recommendations adapted from ADA/EASD consensus report

Drug Guideline Image

Adapted from Buse JB, et al. 20201

*Empagliflozin, canagliflozin and dapagliflozin have shown reduction in HF and CKD progression in CVOTs. Canagliflozin has primary renal outcome data from CREDENCE. Dapagliflozin has primary heart failure outcome data from DAPA-HF.

**Be aware that SGLT2i labelling varies by region and individual agent with regard to indicated level of eGFR for initiation and continued use.

***Proven CVD benefit means it has label indication of reducing CVD events.

CKD - Chronic kidney disease. Specifically eGFR 30-60 mL/min/1.73m2 or UACR >30 mg/g, particularly >300 mg/g.

HF - Heart Failure. Particularly HFrEF (LVEF <45%).

ASCVD - Atherosclerotic cardiovascular disease. Established ASCVD. Indicators of high ASCVD risk (age ≥ 55 years + left ventricular hypertrophy or coronary, carotid, lower extremity artery stenosis >50%).

NICE/SIGN

  • The Scottish Intercollegiate Guidelines Network (SIGN) recommends SGLT2 inhibitors, such as Invokana, as an option for add-on therapy to metformin, in addition to lifestyle measures, for patients with type 2 diabetes who do not achieve an HbA1c of <53 mmol/mol (7.0%) or individual target as agreed.2
  • NICE also suggests SGLT2 inhibitors, such as Invokana, as an option for dual therapy (i.e. at first intensification) for patients whose HbA1c rises to 58 mmol/mol (7.5%) or higher.3
  • An SGLT2i, such as Invokana, can also be considered at second intensification as an add-on to other agents including sulphonylureas, thiazolidinediones and insulin.3

Why choose Invokana?

A bar graph showing benefits of different diabetes drugs

 

Abbreviations

ADA: American Diabetes Association; ASCVD: Atherosclerotic Cardiovascular Disease; CKD: Chronic Kidney Disease; CVOTs: Cardiovascular Outcome Trials; CVD: Cardiovascular Disease; CREDENCE: Canagliflozin and Renal Events in Diabetes with Established Nephropathy Clinical Evaluation; DAPA-HF: Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure; DPP4is: Dipeptidyl Peptidase-4 inhibitors; EASD: European Association for the Study of Diabetes; eGFR: estimated Glomerular Filtration Rate; GLP-1 RA: Glucagon-Like Peptide-1 Receptor Agonists; HbA1c: Haemoglobin A1c; HF: Heart Failure; HFrEF: Heart Failure with reduced Ejection Fraction; LVEF: Left Ventricular Ejection Fraction; NICE: National Institute for Health and Care Excellence; SGLT2i: Sodium-Glucose Co-transporter 2 inhibitor; T2DM: Type 2 Diabetes Mellitus; UACR: Urinary Albumin/Creatinine Ratio.

References
  • 1. Buse J, Wexler D, Tsapas A et al. 2019 Update to: Management of Hyperglycemia in Type 2 Diabetes, 2018. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2020;43(2):487-493. doi:10.2337/dci19-0066.
  • 2. SIGN 154. Pharmacological management of glycaemic control in people with type 2 diabetes, November 2017. Available at: https://www.sign.ac.uk/media/1090/sign154.pdf [Accessed May 2021].
  • 3. NICE NG28. Type 2 diabetes in adults – management, 2015 (Updated 2020). Available at: https://www.nice.org.uk/guidance/ng28 [Accessed May 2021].
  • 4. Downey J. The importance of achieving target HbA1c in the early years. Pract Nurse. 2018;48(1):12-16.
  • 5. Neal B, et al. Canagliflozin and Cardiovascular and Renal Events in Type 2 Diabetes. N Engl J Med. 2017;377(7):644–657. doi: 10.1056/NEJMoa1611925.
  • 6. Inzucchi S, Bergenstal R, Buse J et al. Management of hyperglycaemia in type 2 diabetes, 2015: a patient-centred approach. Update to a Position Statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetologia. 2015;58(3):429-442. doi:10.1007/s00125-014-3460-0.
  • 7. Scirica B, Bhatt D, Braunwald E et al. Saxagliptin and Cardiovascular Outcomes in Patients with Type 2 Diabetes Mellitus. N Engl J Med. 2013;369(14):1317-1326. doi:10.1056/ nejmoa1307684.
  • 8. Rosenstock J, Perkovic V, Johansen O et al. Effect of Linagliptin vs Placebo on Major Cardiovascular Events in Adults With Type 2 Diabetes and High Cardiovascular and Renal Risk. JAMA. 2019;321(1):69. doi:10.1001/jama.2018.18269.
  • 9. Marso S, Bain S, Consoli A et al. Semaglutide and Cardiovascular Outcomes in Patients with Type 2 Diabetes. N Engl J Med. 2016;375(19):1834-1844. doi:10.1056/nejmoa1607141.
  • 10. Green J, Bethel M, Armstrong P et al. Effect of Sitagliptin on Cardiovascular Outcomes in Type 2 Diabetes. N Engl J Med. 2015;373(3):232-242. doi:10.1056/nejmoa1501352.
  • 11. White W, Cannon C, Heller S et al. Alogliptin after Acute Coronary Syndrome in Patients with Type 2 Diabetes. N Engl J Med. 2013;369(14):1327-1335. doi:10.1056/ nejmoa1305889.
  • 12. Pfeffer M, Claggett B, Diaz R et al. Lixisenatide in Patients with Type 2 Diabetes and Acute Coronary Syndrome. N Engl J Med. 2015;373(23):2247-2257. doi:10.1056/ nejmoa1509225.
  • 13. Marso S, Daniels G, Brown-Frandsen K et al. Liraglutide and Cardiovascular Outcomes in Type 2 Diabetes. N Engl J Med. 2016;375(4):311-322. doi:10.1056/nejmoa1603827.
  • 14. Holman R, Bethel M, Mentz R et al. Effects of Once-Weekly Exenatide on Cardiovascular Outcomes in Type 2 Diabetes. N Engl J Med. 2017;377(13):1228-1239. doi:10.1056/ nejmoa1612917.
  • 15. Dormandy J, Charbonnel B, Eckland D et al. Secondary prevention of macrovascular events in patients with type 2 diabetes in the PROactive Study (PROspective pioglitAzone Clinical Trial In macroVascular Events): a randomised controlled trial. The Lancet. 2005;366(9493):1279-1289. doi:10.1016/s0140-6736(05)67528-9.