Transitioning to GLP-1 RAs and SGLT2 Inhibitors as the First Choice for Managing Cardiometabolic Risk in Type 2 Diabetes

Diabetes and Stroke: Impact of Novel Therapies for the Treatment of Type 2 Diabetes Mellitus

“…Several mechanisms have been proposed for the cardiorenal benefits of SGLT2is, namely decreased blood pressure; modest weight loss; improvement of cardiac energy metabolism; prevention of inflammation, ischemia-reperfusion injury, and adverse cardiac remodeling; and inhibition of the sympathetic nervous system [58]. The decrease in glucose and sodium reabsorption achieved by the inhibition of SGLT2 leads to a decrease in HbA1c and global glucotoxicity.…”

“…Tirzepatide is a dual GLP-1 and GIP receptor agonist, approved by the Food and Drug Administration (FDA) and later by the European Medicines Agency (EMA) for T2DM [58,85].…”

“…As previously mentioned, since 2022, the ADA and EASD consensus, and also the current ADA Standards of Care, propose that GLP1-Ra and/or SGLT2i be included in people with T2DM and established or high risk for CVD, HF, and/or CKD to reduce the cardiovascular risk [25,52]. However, given that there is evidence suggesting a greater benefit of GLP1-Ra in atherosclerotic disease and stroke, currently, several authors propose the preferential use of this pharmacological group in patients with a previous history of stroke [49,58]. Pioglitazone is also a drug to be considered by the ADA and the EASD after the previously mentioned drugs in patients with established atherosclerotic CVD [25,52].…”

Effects of once‐weekly glucagon‐like peptide‐1 receptor agonists on type 2 diabetes mellitus complicated with coronary artery disease: Potential role of the renin‐angiotensin system

“…Moreover, long‐acting GLP‐1 RA are used once a week, which reduce the frequency of medication, greatly reduce the problems of daily medication and have higher patient compliance. In recent years, multiple large cardiovascular outcome trials have shown that GLP‐1 RA lower blood pressure (BP), lower blood lipids, provide cardiovascular protection and reduce the occurrence of cardiovascular disease 8–10 . According to the latest guidelines published by the American Diabetes Association and the European Association for the Study of Diabetes, GLP‐1 RA are strongly recommended as first‐line treatment for patients with cardiovascular disease and diabetes mellitus 11,12 .…”

“…In recent years, multiple large cardiovascular outcome trials have shown that GLP-1 RA lower blood pressure (BP), lower blood lipids, provide cardiovascular protection and reduce the occurrence of cardiovascular disease. [8][9][10] According to the latest guidelines published by the American Diabetes Association and the European Association for the Study of Diabetes, GLP-1 RA are strongly recommended as first-line treatment for patients with cardiovascular disease and diabetes mellitus. 11,12 It has been reported that GLP-1 RA may play an important role in antioxidant, anti-inflammatory, anti-apoptosis, improvement of mitochondrial function and endothelial dysfunction, inhibition of viscous molecule expression, reactive oxygen generation and inhibition of thrombosis, which may be the potential mechanism of GLP-1 RA for cardiac protection.…”