Cardiovascular and Renal Outcomes in Type 2 Diabetes Medications with Dr. Marie McDonnell


The number of medications available to treat diabetes continues to increase. Recently, there has been widespread interest in two classes of medications, the SGLT2 inhibitors and the GLP1 agonists. They have created quite the splash with improvements in cardiovascular outcomes in patients with type 2 diabetes. In this podcast we take a deeper dive with our expert Dr Marie McDonnell to look at these drug classes and explore where they fit into type 2 diabetes management.


00:17 - Introduction
02:14 – Introduction of guest, Dr Marie McDonnell
02:14 – SGLT2 inhibitors and GLP1 agonist, the basics: what they are, mechanisms of actions and how are they taken?
05:12 – Cardiovascular outcome trials of EMPA-REG
08:20 – Cardiovascular outcome trials of the other SGLT2 inhibitors (CANVAS and DECLARE-TIMI)
11:05 – Heart failure hospitalizations and SGLT2 inhibitors
12:20 – SGLT2 inhibitors and implications for treatment guidelines
13:00 – Renal outcomes and SGLT2 inhibitors
15:00 – Potential mechanisms of action to account for these cardiovascular and renal benefits
17:11 – Cautions with of SGLT2 inhibitor use, euglycemic ketoacidosis and how to avoid it
19:20 – Cardiovascular outcome trials of the GLP-1 agonists (LEADER)
24:05 – Differentiating the effects of SGLT2 inhibitors vs GLP-1 agonists on the different mechanisms of heart disease
24:32 – Clinical case scenario
25:30 – Approach to management
27:23 – Personalization of diabetes management
27:45 – GLP1 agonist vs. SGLT2 inhibitor, when to use and why?
29:25 – What to do with GLP-1 agonists or SGLT2 inhibitors in the hospitalized patient
32:12 – Absolute contraindications in GLP-1 agonists and SGLT2 inhibitors
34:44 – Future directions of type 2 diabetes care and medications
37:10 – Take-aways and conclusions 

Additional Resources:

1. DECLARE Dapagliflozin trial
2. EMPA-REG trial
3. CANVAS trial
4. CANVAS-R trial
5. LEADER trial

The Curbside Consults series complements the foundational information in NEJM R360 Rotation Prep by taking a deep dive into key clinical topics with expert clinicians and educators. These podcasts explore and critique the evidence behind clinical practice and break down statistical concepts for the busy clinical trainee.

 Dr Marie McDonnell is an Endocrinologist and the Director of Diabetes at Brigham and Womens’ Hospital and Lecturer in Medicine at Harvard Medical School.


Angela Chen is a 2018-2019 NEJM editorial fellow. She is an endocrine fellow who trained at Flinders Medical Centre and the Royal Adelaide Hospital. Angela received her medical degree from the University of Adelaide, and masters of public health from the University of Sydney. Her clinical and research interests are in the areas of glucocorticoid and cardiovascular endocrinology and diabetes medicine.

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