Diabetes Mellitus and Cardiovascular Disease: An Evidence Based Review of Provincial Formulary Coverage

Publication date: Available online 19 July 2018Source: Canadian Journal of CardiologyAuthor(s): Shivraj S. Riar, David Fitchett, Jeremy FitzGerald, Payam DehghaniAbstractCardiovascular mortality is the primary cause of death in patients with Type 2 Diabetes Mellitus (T2DM). Recently, clinical trials of the Sodium Glucose Transport Protein 2 (SGLT-2) Inhibitors Empagliflozin and Canagliflozin and of the Glucagon Like Peptide-1 (GLP-1) Agonists Liraglutide and Semaglutide demonstrated the agents reduced cardiovascular events. Furthermore, Empagliflozin and Liraglutide reduced cardiovascular mortality. However, despite the proven cardiac benefits, many but not all Provincial Formularies have restrictive rules for payment and access for SGLT-2 Inhibitors and GLP-1 Agonists. These restrictions impede a practitioner’s ability to provide optimal care for patients with T2DM and CVD. The 2018 Diabetes Canada Guidelines recommend the use of a glucose lowering agent with proven cardiovascular benefit (ie Empagliflozin, Canagliflozin, Liraglutide or Semaglutide) as second line therapy after Metformin, for patients with type 2 diabetes and CVD who fail to achieve the glycemic target of A1C <7% with Metformin. We recognize that provinces must allot resources especially when health care budgets are limited and not able to provide all available treatments. However today we have glucose lowering agents that reduce mortality in patients at very high cardiovascular risk. Furthermore, for ...
Source: Canadian Journal of Cardiology - Category: Cardiology Source Type: research