Background  
The management of patients with type 2 diabetes mellitus (T2DM) has shifted in the past years from a glucose-centric to a multifactorial approach targeting the existing cardiometabolic risk factors. Recent guidelines emphasize this concept through their therapeutic algorithms that focus not only on lowering blood glucose levels and on the avoidance of hypoglycaemia, but also, sometimes foremost, on the beneficial cardiorenal effects, while also preventing weight gain and even promoting weight loss. However, the first step in choosing an individualised treatment for patients with T2DM is to perform a comprehensive assessment of comorbidities and risk factors.

Aim  
The aim of our study was to evaluate the characteristics of patients with type 2 diabetes mellitus admitted to a cardiology unit from the Western part of Romania and to analyse their impact on the choice of antihyperglycemic pharmacologic agents.

Method  
In this cross-sectional, non-interventional study, we enrolled 73 patients previously diagnosed with T2DM and atherosclerotic CVD (ASCVD) that have been referred to the Diabetes Compartment of the Emergency Hospital Timisoara from Institutul de Boli Cardiovasculare Timisoara (IBCV) between November 2019 and July 2021 in the context of a novel interdisciplinary collaboration between the diabetology and cardiology departments Data regarding the patients’ age, body mass index (BMI), HbA1c, estimated glomerular filtration rate (eGFR), left ventricular ejection fraction (LVEF) and the antihyperglycemic agents prescribed by physicians from other medical centres based in different geographical areas of Romania before the admittance to IBCV were collected from the patients’ medical records alongside with the new recommendations of treatment that have been noted in the hospital discharge documents.

Results  
The enrolled patients had a median age of 69 [10] years, with a mean BMI of 30.7 ± 5.4 kg/m(2) and a mean HbA1c of 7.5 ± 1.9%, 63.0% of them (n=46) being males. Furthermore, 31.5% (n=23) of the patients had heart failure with reduced ejection fraction (HFrEF), while 1.3% (n=1) of the patients had missing information regarding this diagnosis. With regard to the kidney function, 41.0% of the patients (n=30) had an eGFR ≥ 60 mL/min/1.73 m(2), 19.1% (n=14) had an eGFR between 45-59 mL/min/1.73 m(2), 12.3% (n=9) between 30-44 mL/min/1.73 m(2), 13.6% (n=10) had an eGFR lower than 30 mL/min/1.73 m(2) and for 13.6% (n=10) patients the eGFR was not available.

Discussion  
Before their admission to IBCV, only 10.8% (n=8) of the total number of patients with T2DM and ASCVD have been treated with a glucagon-like peptide-1 receptor agonist or a sodium-glucose co-transporter-2 inhibitor, partly explained in some cases by comorbidities and a decreased eGFR. However, the percentage has increased to 47.9% after the recommendations that were made as part of the aforementioned collaboration. In conclusion, an increased awareness about the cardiovascular and renal impact of T2DM followed by an extensive assessment of cardiometabolic risk factors and comorbidities and consequent prescription of antidiabetic drugs with pleiotropic effects could have a paramount impact in decreasing mortality and morbidity in these complex patients.

References  
ADA. 9. Pharmacologic approaches to glycemic treatment: Standards of Medical Care in Diabetes-2021. Diabetes Care 2021;44 (Suppl. 1):S111–S124



CHARACTERISTICS OF PATIENTS WITH TYPE 2 DIABETES MELLITUS AND CARDIOVASCULAR DISEASE – A CROSS-SECTIONAL STUDY