Special attention to glucose-lowering medication with proven CV benefit and/or safety in 2023 ESC diabetes guidelines

2023 ESC Guidelines for the management of cardiovascular disease in patients with diabetes

News - Aug. 25, 2023

Presented at the ESC congress 2023 by: Nikolaus Marx, MD - Aachen, Germany and Massimo Federici, MD - Rome, Italy

Since the latest version of the ESC Guidelines on diabetes, pre-diabetes and cardiovascular diseases in 2019, a lot of evidence in large CV outcome trials has been gathered. These new data have been evaluated by the Task Force resulting in recommendations in the new 2023 ESC Guidelines for the management of cardiovascular disease in patients with diabetes.

These new 2023 Guidelines focus on CVD and diabetes, leaving aside pre-diabetes (due to lack of clear evidence). Recommendations are provided on CV risk stratification, screening, diagnosis, and treatment of CVD in patients with diabetes.

Recommendations for screening

  • In all individuals with CVD, screening for diabetes (using fasting glucose and/or HbA1c) is recommended (Class I, A).
  • In patients with T2D, it is recommended to assess medical history and the presence of symptoms suggestive of ASCVD (Class I, B).
  • In all patients with T2D, a systematic survey for HF symptoms and/or signs of HF at each clinical encounter is recommended (Class I, C).
  • It is recommended to routinely screen patients with T2D for kidney disease by assessing eGFR and UACR (Class I, B).

Recommendations for glucose-lowering treatment

  • Prioritize the use of glucose-lowering agents with proven CV benefits followed by agents with proven CV safety over agents without proven CV benefit or proven CV safety (Class I, C).
  • Switch glucose-lowering treatment from agents without proven CV benefit of proven CV safety to agents with proven CV benefit (Class I, C).

Treatment recommendations

  • In patients with T2D and ASCVD, GLP-1RA and SGLT2-inhibitors are recommended to reduce CV risk independent of glucose control (Class I)
  • In all patients with T2D and HF (HFrEF, HFmrEF, HFpEF), SGLT2 inhibitors are recommended to reduce HF hospitalization (Class I).
  • In patients with T2D and CKD, SGLT2 inhibitors and finerenone are recommended to reduce CV and kidney failure risk (Class I).

CV risk stratification

  • The novel T2D-specific risk score SCORE2-Diabetes is introduced to asses the CV risk in patients with T2D without ASCVD or severe target-organ damage (TOD).

Other aspects

  • In the guidelines, recommendations are made on lifestyle, glycemic target, BP management, lipid management, antithrombotic therapy, and a multifactorial approach to risk-factor management to reduce CV risk in patients with T2D.

- Our reporting is based on the information provided at the ESC Congress -

Find here the full publication of the 2023 ESC Guidelines for management of CVD in diabetes Watch a video by Nikolaus Marx

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