Understanding Heart and Kidney Risk in Type 2 Diabetes
A recent study, published in the American Heart Association’s prestigious journal Circulation, has shed light on the potential of a straightforward blood test in predicting the risk of progressive heart and kidney risk in patients afflicted with type 2 diabetes as well as kidney disease.
Identifying Biomarkers for Heart and Kidney Complications
Dr. James Januzzi, the Hutter Family Professor of Medicine at Harvard Medical School, a prominent cardiologist at Massachusetts General Hospital, and the director of heart failure and biomarker trials at the Baim Institute for Clinical Research in Boston, spearheaded this groundbreaking research. According to Dr. Januzzi, “High levels of certain biomarkers are indicators of heart and kidney risk, and complications, they may help predict future risk of disease progression.”
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Canagliflozin and Its Impact
The study delved into the impact of canagliflozin, a sodium-glucose co-transporter 2 inhibitor, on these biomarkers and their relevance in assessing future risks. Dr. Januzzi noted that “Treatment with canagliflozin lowered biomarker levels and reduced the risk of hospitalization for heart failure and other heart complications in people at the highest risk.”
The Role of Biomarkers
Health professionals routinely use biomarkers to screen, diagnose, or treat specific medical conditions. Previous research has indicated that concentrations of certain biomarkers can predict the onset and progression of chronic kidney disease and cardiovascular events in individuals with diabetes.
Study Findings
The research team examined biomarker data from 2,627 participants involved in the Canagliflozin and Renal Events in Diabetes with Established Nephropathy Clinical Evaluation (CREDENCE) trial. This analysis included measurements taken at the study’s outset, the one-year mark, and the three-year mark.
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The study aimed to assess the prognostic value of these biomarkers regarding kidney problems and the risk of death due to kidney disease or cardiovascular disease, categorizing patients into low, medium, and high-risk groups. Notably, individuals at the highest risk exhibited significantly higher rates of progressive kidney failure and cardiovascular complications throughout the three-year study period.
Key Study Findings
The analysis revealed the following key findings:
High initial concentrations of each biomarker strongly correlated with the severity of heart and kidney issues in participants.
Participants taking canagliflozin exhibited lower biomarker levels after one year and three years compared to those taking a placebo.
After one year, participants on canagliflozin experienced biomarker level increases of 3% to 10%, compared to an increase of 6% to 29% in those on the placebo.
Future Research and Implications
Dr. Januzzi emphasized the importance of future studies in understanding how Type 2 diabetes and kidney disease develop and progress. This knowledge could lead to the initiation of life-saving therapies before symptoms of heart and kidney risk manifest. Moreover, given the endorsement of biomarker measurement by the American Heart Association, American College of Cardiology, and the American Diabetes Association, these results have the potential to expand the utility of biomarker-based testing, enhancing accuracy further.
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Study Limitations
The study did have some limitations, as not all participants in the CREDENCE trial had available samples for biomarker measurement. Furthermore, the participants with biomarker measurements may not be entirely representative of the study’s overall population. Additionally, the biomarker data over time were incomplete, and some participants had missing values during the follow-up period. Although prognostic thresholds have been identified for two of the biomarkers regarding the risk of kidney and heart complications in Type 2 diabetes patients, these thresholds remain exploratory for the other two.
Background: The CREDENCE Trial
The CREDENCE trial, conducted from 2014 to 2018, aimed to compare the effectiveness of a placebo to 100 mg of canagliflozin in treating Type 2 diabetes. Canagliflozin works within the kidneys to prevent the absorption of glucose. The participants in this phase 3 clinical trial had Type 2 diabetes and chronic kidney disease, and the trial concluded that canagliflozin was more effective than the placebo in reducing cardiovascular disease and kidney failure.
The Analyzed Biomarkers
The four biomarkers under scrutiny in the study were:
N-terminal pro-B-type natriuretic peptide
High-sensitivity cardiac troponin T
Growth differentiation factor-15
Insulin-like growth factor binding protein 7
