ECE2021 Audio Eposter Presentations Diabetes, Obesity, Metabolism and Nutrition (223 abstracts)
Treatment recommendations for dapagliflozin across a cardio-renal and viscero metabolic (crv-m) continuum: an expert consensus delphi study
Ashok Das 1 , Rajeev Awasthi 2 , Manisha Sahay 3 , Abhay Sahoo 4 , Prakash Hazra 5 , Nitin Kapoor 6 , Mangesh Tiwaskar 7 , Prashant Bhandarkar 8 , Rakesh Sahay 3 , Saptarshi Bhattacharya 9 , Banshi Saboo 10 , Kaushik Pandit 11 , Kamal Kishor 12 , Tiven Marwah 13 , Navneet Agrawal 14 , Kamal Sharma 15 , Umesh Khanna 16 , Ganapathi Bantwal 17 , Ameya Joshi 18 , Prafulla Kerkar 19 & Sanjay Kalra 20
1Pondicherry Institute of Medical Sciences, Endocrine, Puducherry, India; 2Prarthana Clinic & Diabetes Care Centre, Lucknow, India; 3Osmania General Hospital, Hyderabad, India; 4SUM hospital, Bhubaneswar, India; 5AMRI Hospital - Dhakuria, Kolkata, India; 6Christian Medical College, Vellore, India; 7Shilpa Medical Research Centre, Mumbai, India; 8Gastroenterology And Endoscopy Centre, Nagpur, India; 9Max Healthcare, New Delhi, India; 10Dia Care - Diabetes Hormone Clinic, Ahmedabad, India; 11Fortis Medical Centre, Kolkata, Kolkata, India; 12Rama Heart Centre, Karnal, India; 13le Bonheur Diabetes Thyroid And Endocrine Centre, Ahmedabad, India; 14Diabetes Obesity and Thyroid Center, Gwalior, India; 15SAL Hospital & Medical Institute, Ahmedabad, India; 16Lancelot Medical Center, Mumbai, India; 17Saint Johns Hospital, Bengaluru, India; 18Bhaktivedanta Hospital and Research Institute, Mumbai, India; 19King Edward Memorial Hospital, Mumbai, India; 20Bharti Research Institute of Diabetes and Endocrinology (BRIDE), Karnal, India
Introduction
Dapagliflozin is sub-optimally utilised in the real world. There is a lack of a comprehensive collaborative guidance for a practical approach to manage patients with cardiometabolic, renometabolic and viscerometabolic disorders. Patients across the CRV-M continuum includes patients with varied clinical profiles.
Methods
Two round Delphi study was conducted using a virtual online-digital connect approach with 35 clinicians with cumulative clinical experience of 1050 man years of experience across different specialties. This was preceded by contemporary evidence-based discussion on therapeutic approaches, through multidisciplinary modules for six hours covering cardiometabolic, renometabolic and viscerometabolic disorders, with focus on dapagliflozin. A consensus was reached on the clinical aspects that were endorsed by 50% or more of the experts
Results
Of the total 33 questions, seven were unanimously (100%) rated with the same response and 12 received the same response by > 50% of the participants. The mean man years of experience of the respondents with unanimous response was 175.7 years (± 43.92, minimum 120, maximum 240, 95% CI 135.1 to 216.3) significantly higher as compared to respondents > 50% similar response 122.5 years (± 10.74, minimum 60, maximum 180, 95% CI 98.86 to 146.1) (P = 0.0118). The index weighted impact score based on the man years of experience was higher for the unanimous responses group (1.43). There was a unanimous consensus, with absolute agreement for the cardiometabolic based chronic disease (CMBCD) approach, SGLT2 inhibitors as emerging approach to address the residual risk, and reduction of single-nephron glomerular filtration rate as a mechanism for renoprotection. 88% participants attributed insulin resistance as an important reason for autonomic dysfunction in patients with T2DM. The DAPA-CKD and DAPA-HF trials appears to have a potential scientific impact in the real-world utilisation of Dapagliflozin in patients with DKD and HFrEF.
Conclusion
The results of this study suggest that irrespective of presence of diabetes, dapagliflozin has a potential to optimise the management of patients. Dapagliflozin, beyond the ability to increase glycosuria, with relatively higher level of evidence, across the CRV-M continuum, appears to be a promising agent.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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