American Diabetes Association

Conference summaries



Presented by: Rajiv Agarwal, MD
Indiana University School of Medicine, Indianapolis, IN, USA
Meg J. Jardine, MD
The George Institute for Global Health, UNSW Sydney, Sydney, NSW, Australia
Bruce Neal, MD
The George Institute for Global Health, UNSW Sydney, Sydney, NSW, Australia;
Epidemiology and Biostatistics, Imperial College London, London, UK

Kenneth W. Mahaffey, MD
Stanford University School of Medicine, Stanford, CA, USA
Bernard Zinman, MD
University of Toronto, Toronto, ON, Canada
  • In cardiovascular (CV) trials of sodium-glucose cotransporter 2 (SGLT2) inhibitors, exploratory results have suggested that these drugs may improve renal outcomes in patients with type 2 diabetes.
  • The CREDENCE (Canagliflozin and Renal Endpoints in Diabetes with Established Nephropathy Clinical Evaluation) trial evaluated the effects of canagliflozin on renal outcomes in patients with type 2 diabetes and albuminuric chronic kidney disease (CKD).

In several trials performed to meet regulatory requirements for CV safety, reductions in CV events with SGLT2 inhibitors have been found. Secondary and exploratory analyses of these trials suggested that SGLT2 inhibition might improve renal outcomes; however, relatively few patients reached end-stage kidney disease and patients in these trials were at low risk for kidney failure. Many renal effects of SGLT2 inhibition have been proposed.

  • To assess whether canagliflozin has a renal and vascular protective effect in reducing the progression of renal impairment relative to placebo in patients with type 2 diabetes mellitus, Stage 2 or 3 CKD, and macroalbuminuria, who are receiving standard of care including a maximum tolerated labeled daily dose of an angiotensin-converting enzyme inhibitor (ACEi) or angiotensin receptor blocker (ARB).

Type of study, patients, and inclusion criteria

  • Double-blind, randomized trial, in 4,401 patients with type 2 diabetes and albuminuric CKD to receive canagliflozin (n=,2202; 100 mg/day) or placebo (n=2,199).
  • All patients had an estimated glomerular filtration rate (eGFR) of 30 to <90 ml/min/1.73 m2 and albuminuria (ratio of urine albumin (mg) to creatinine (g), >300 to 5,000) and were treated with renin–angiotensin system blockade.

Primary outcome measure

The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained eGFR of <15 ml/min/1.73 m2), a doubling of serum creatinine level, or death from renal or CV causes.

  • Median follow-up was 2.6 years.
  • The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (HR 0.70; 95% CI, 0.59 to 0.82; P = 0.00001).
  • In the canagliflozin group, the relative risk of the renal-specific composite of end-stage kidney disease, a doubling of creatinine level, or death from renal causes was lower by 34% (HR 0.66; 95% CI, 0.53 to 0.81; P <0.001) than in the placebo group, and the relative risk of end-stage kidney disease was lower by 32% (HR 0.68; 95% CI, 0.54 to 0.86; P=0.002) (Figure).
  • The canagliflozin group also had a lower risk of CV death, myocardial infarction, or stroke (HR 0.80; 95% CI, 0.67 to 0.95; P = 0.01) and hospitalization for heart failure (HF 0.61; 95% CI, 0.47 to 0.80; P<0.001).
  • The safety profile was consistent with previous studies on canagliflozin, with no difference vs. placebo for rates of fracture or amputation.
  • Canagliflozin reduced the risk of kidney failure and prevented CV events in patients with type 2 diabetes and CKD.
  • Canagliflozin reduced major CV events and renal outcomes across a broad spectrum of patients including those without CV disease at baseline.

Key messages/Clinical Perspectives

  • Canagliflozin can be used for both primary and secondary prevention of major CV events in patients with type 2 diabetes and CKD.


Trial: NCT02065791



Perkovic V, Jardine MJ, Neal B, et al. Canagliflozin and Renal Outcomes in Type 2 Diabetes and Nephropathy. N Engl J Med. 2019 Jun 13;380(24):2295-306. doi: 10.1056/NEJMoa1811744.

Present disclosure: R. Agarwal: none. Meg Jardine: Akebia, Baxter, Boehringer Ingelheim, CSL Behring, Vifor, Amgen, Eli Lilly, Gambro, Merck Sharp & Dome, Janssen. B. Neal: Janssen, Novarits, Pfizer, Roche, Servier, Abbott. K.W. Mahaffey: Abbott, Ablynx, Baim Institute, Boehringer Ingelheim, Bristol-Myers Squibb, Cardiometabolic Health Congress, Elsevier, GlaxoSmithKline, Medergy, Medscape, Mitsubishi Tanab, MyoKardia, Novo Nordisk, Ocleuve, Portola, Radiometer America, Springer Publishing, Theravance, UCSF, AstraZeneca, Johnson & Johnson, Merck, National Institutes of Health, Novartis, Afferent, Amgen, Apple, Cardiva Medical, Daiichi, Ferring, Google, Luitpold, Medtronic, Sanofi, St. Jude, Tenax, BioPrint Fitness. B. Zinman: Abbott, AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Eli Lilly, Janssen, Merck, Novo Nordisk.

Written by: Patrick Moore, PhD

Reviewed by: Marco Gallo, MD

All report

Welcome to the ADA 2019 Highlights

Jose C. Florez, MD, PhD
Chair, ADA Scientific Sessions Meeting Planning Committee
The 79th American Diabetes Association’s Scientific Sessions were held in San Francisco, California from June 7-11, 2019. The meeting was attended by over 15,000 professional attendees from 115 countries, … [ Read all ]



The Vitamin D and Type 2 Diabetes (D2d) Study—A Multicenter Randomized Controlled Trial for Diabetes Prevention

Presented by: Anastassios G. Pittas, MD; Erin S. LeBlanc, MD, MPH; Myrlene Staten, MD; for the D2d Research Group


Longitudinal Outcomes in Youth with Type 2 Diabetes—The TODAY2 Study

Presented by: Kimberly L. Drews, MD, PhD; Lorraine E. Levy Katz, MD; Petter Bjornstad, MD; Neil H. White, MD; Jeanie B. Tryggestad, MD; Ruth S. Weinstock, MD, PhD; for the TODAY2 Study Group


Once-Weekly Dulaglutide and Major Cardiovascular Events—Results of the REWIND Trial

Presented by: Gilles R. Dagenais, MD; Rafael Diaz, MD; Matthew C. Riddle, MD; Hertzel C. Gerstein, MD, MSc; Helen Colhoun, MD; Jeffrey L. Probstfield, MD; Hertzel C. Gerstein, MD, MSc


PREVIEW: PREVention of diabetes through lifestyle Intervention and population studies in Europe and around the World

Presented by: Ian Macdonald, MD; Edith Feskens, MD, MPH; Margriet Westerterp-Platenga, MD; Mathijs Drummen, MD


Results and Comparisons from the RISE Clinical Trial—Adult Medication Study

Presented by: David A. Ehrmann, MD; Kieren J. Mater, MD; Sharon Edelstein, ScM; Steven E. Khan, MD, ChB; Thomas A. Buchanan, MD; Sonia Caprio, MD



Presented by: Itamar Raz, MD; Stephen D. Wiviott, MD; John P. Wilding, MD; Ofri Mosenzon, MD; Lawrence A. Leiter, MD


The CAROLINA Trial—First Results of the Cardiovascular Outcomes Trial Comparing Linagliptin vs. Glimepiride

Presented by: Julio Rosenstock, MD; Mark A. Espeland, MD; Steven E. Kahn, MD; Nikolaus Marx, MD; Bernard Zinman, MD



Presented by: Rajiv Agarwal, MD; Meg J. Jardine, MD; Bruce Neal, MD; Kenneth W. Mahaffey, MD; Bernard Zinman, MD



Presented by: Steven E. Kahn, MD; Nikolaus Marx, MD; Darren K. McGuire, MD; Christoph Wanner, MD; Mark E. Cooper, MD


Oral Semaglutide—The PIONEER Program Trials

Presented by: Vanita R. Aroda, MD; Richard E. Pratley, MD; Stephen C. Bain, MA, MD, FRCP; Mansoor Husain, MD, FRCPC; John B. Buse, MD, PhD; Vivian Fonseca, MD



ADA Nutrition Therapy for Adults with Diabetes—2019 Consensus Report

Presented by: Alison B. Evert, MD; Janice MacLeod, MA, RDN, CDE; William S. Yancy, Jr., MD, MHS; W. Timothy Garvey, MD; Ka Hei Karen Lau, MS, RD, LDN, CDE; Christopher D. Gardner, PhD; Kelly M. Rawlings, MS



Cardiovascular and Renal Protection in Diabetes—Emphasis on SGLT2 Inhibitors and GLP-1 Receptor Agonists

Presented by: Julie A. Lovshin, MD, PhD; Jens J. Holst, MD, DMSc; David C. Wheeler, MD


Nonalcoholic Fatty Liver Disease (NAFLD) and Nonalcoholic Steatohepatitis (NASH)—The Overlooked Complications of Type 2 Diabetes

Presented by: Elisabetta Bugianesi, MD, PhD; Zobair Younossi, MD, MPH; Kenneth Cusi, MD


Controversies in the Evaluation and Management of Dyslipidemia in Patients with Diabetes

Presented by: Amy Sanghavi Shah, MD, MS; Dan Streja, MD; Savitha Subramanian, MD; Lisa Tannock, MD


Hypoglycemia in Type 2 Diabetes

Presented by: Kamlesh Khunti, MD, PhD, FRCGP, FRCP; Elizabeth Selvin, PhD, MPH; Frans Pouwer, PhD; Sophia Zoungas, MBBS (Hons), PhD, FRACP