On the agenda at the 55th annual European Association for the Study of Diabetes (EASD) meeting in Barcelona, was a large multinational observational study.

The study found that cardiorenal disease is the most common cardiovascular manifestation that occurs first in type 2 diabetes (T2D). Due to the overall lack of knowledge surrounding cardiorenal disease in those without established cardiovascular disease (CVD), the study aimed to investigate the development and mortality rates associated with heart failure (HF) and chronic kidney disease (CKD) in T2D patients.

T2D patients with a history of CKD or CVD were identified from health insurance registries in Germany (DE) and Japan (JP), as well as population registries in Norway (NO) and Sweden (SE). Entries were recorded when any of the following diagnoses first arose: stroke, myocardial infarction (MI), peripheral artery disease, or cardiorenal disease (HF + CKD). The study investigated a total of 996,629 T2D patients. A total of 687,732 patients (69% of the total study population) were free of CVD and CKD and were followed for a mean of 3.9 years or 2.7 million patient years. Of the 99,292 patients (14%) that developed a CV manifestation, the most common was cardiorenal disease, with an incidence of 68% in Germany, 59% in Japan, 52% in Norway, and 48% in Sweden. This was followed by a stroke in Japan and MI or stroke in Germany, Norway, and Sweden. Of the cardiorenal events, 46% were HF and 54% were CKD across all countries. HF led to an increased risk of CKD (hazard risk [HR] 2.71; 1.88–3.92) and CKD increased the risk of HF (HR 2.14; 1.57–2.91) across all countries. There was an increased risk of all-cause mortality with CKD (HR 1.76; 1.45–2.15), HF (HR 2.17; 1.78–2.65), and HF + CKD (HR 3.08; 2.41–3.94), compared to CVD-free T2D. CKD and HF were separately associated with an increase in CV mortality and significantly increased risks for MI and stroke, respectively.

The study concluded that in T2D patients without a history of CVD, cardiorenal disease is consistently observed as the most common CVD manifestation and is associated with a significantly increased risk of all-cause death. Cardiorenal disease is clearly a major comorbidity associated with T2D, and GlobalData is confident that more CVD and renal outcome trials will be initiated by drug developers to address this increasingly prevalent comorbidity, thereby bolstering the uptake of the currently available T2D therapeutics. Sodium-glucose co-transporter-2 (SGLT-2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists are two T2D drug classes that have increasingly demonstrated strong efficacy in recent T2D and cardiovascular risk outcomes trials. Despite advances being made by several large drug companies in the T2D space, GlobalData believes that there is still a clear and unmet need for therapies that fully address cardiorenal disease secondary to T2D.

Related report
GlobalData (2019). Type 2 Diabetes – Global Drug Forecast and Market Analysis to 2028, to be published