Advances in type 2 diabetes therapy: a focus on cardiovascular and renal outcomes

Abstract

Summary Treatment options for type 2 diabetes have expanded. While metformin remains the first line treatment in most cases, choices for second line treatment now extend beyond sulfonylureas and include the sodium–glucose cotransporter 2 (SGLT2) inhibitors, glucagon‐like peptide 1 (GLP1) receptor agonists, and dipeptidyl peptidase 4 (DPP4) inhibitors. SGLT2 inhibitors are recommended for people with atherosclerotic cardiovascular disease, heart failure or kidney disease. Diabetic ketoacidosis is an uncommon but important side effect; its occurrence can be minimised with appropriate patient education and management, especially during perioperative periods and times of illness. GLP1 receptor agonists are recommended for people with atherosclerotic cardiovascular disease. Gastrointestinal side effects are common but are less prominent with the longer acting agents and can be minimised with slow titration of the shorter acting agents. DPP4 inhibitors are generally well tolerated, but alogliptin and saxagliptin should be used with caution in people with risk factors for heart failure. To optimise the management of type 2 diabetes, clinicians need to be aware of the pharmacological characteristics of each class of blood glucose‐lowering medications and of the effect on cardiovascular health and renal function, balanced by potential adverse effects. Medications that have cardiovascular or renal benefits should be prescribed for patients with these comorbidities, and this is reflected in recent international guidelines.

Effect of different antidiabetic medications on atherosclerotic cardiovascular disease (ASCVD) risk score among patients with type-2 diabetes mellitus: A multicenter non-interventional observational study

“…It was found that patients using DDP4 inhibitor-metformin compared to the sulfonylurea-metformin combination reported lower hospital visits. The reason for these findings might be due to reduced incidence of hypoglycemia with DDP4 inhibitor and their improved glycemic control leading to fewer risks of emergency conditions like diabetic ketoacidosis [ 24 , 26 – 29 ]. Combination of SU or DPP-4 inhibitors were prescribed more to the patients with worse comorbidities than control group (G1) metformin only.…”

Feasibility of once weekly exenatide‐LAR and enhanced diabetes care in Indigenous Australians with type 2 diabetes (Long‐acting‐Once‐Weekly‐Exenatide laR‐SUGAR, ‘Lower SUGAR’ study)

“…Previous studies have shown glucose lowering benefits of exenatide‐LAR 10,24–27 . Recent trials using GLP‐1 receptor agonists have shown both glucose‐lowering and added CVD protection 10 .…”

“…Previous studies have shown glucose lowering benefits of exenatide-LAR. 10,[24][25][26][27] Recent trials using GLP-1 receptor agonists have shown both glucose-lowering and added CVD protection. 10 This study highlights the importance of a model of care that incorporates the use of one of these agents safely and effectively in a high-risk population.…”

“…8,9 The development of the class of glucagon-like peptide 1 (GLP-1) receptor agonists represents one of the major advances in diabetes management in the past decade. 10 As well as leading to glucose lowering, GLP-1 receptor agonists lead to significant weight loss, along with improvements in other cardiovascular risk factors including blood pressure, 11 albuminuria 10 and have beneficial effects on lipid profile. 11 Exenatide-LAR is an incretin analogue, administered weekly, that shares glucoregulatory properties with GLP-1 receptor agonists.…”

Efeitos dos análogos do GLP-1 e dos inibidores do SGLT-2 nos desfechos cardiovasculares em pacientes portadores de Diabetes Mellitus tipo 2 / Effects of GLP-1 analogues and SGLT-2 inhibitors on cardiovascular outcomes in patients with type 2 Diabetes Mellitus

“…20213.2 EFEITOS DOS iSGLT-2 E DOS ANÁLOGOS DO GLP-1 NOS DESFECHOS CARDIOVASCULARES EM PACIENTES COM DM2Os iSGLT-2 são medicamentos antidiabetogênicos, cujo mecanismo de ação consiste na inibição da reabsorção de glicose e de sódio no túbulo contorcido proximal renal, o que acarreta em glicosúria e em natriurese, como supracitado. Possuem como principais representantes a Dapagliflozina, nas dosagens de 5 a 10 mg e a Empagliflozina, em doses de 10 a 25 mg. São administrados por via oral, sendo capazes de reduzir a HbA1c em torno de 0,5% a 1%(LIBIANTO R, et al, 2020). Além disso, raramente induzem hipoglicemia e o seu uso proporciona melhora nos valores da glicose sérica, da pressão arterial, do peso corporal e da albuminúria, ao reduzirem os volumes plasmático e pressórico(RODRIGUES LL, et al, 2020).…”