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

  • Evidence-Based Medicine, Clinical Trials and Their Interpretations​ (K. Nasir, Section Editor)
  • Published:
Current Atherosclerosis Reports Aims and scope Submit manuscript

Abstract 

Purpose of Review

This forward-looking review summarizes existing evidence from cardiovascular outcome trials on cardiometabolic risk-reduction in type 2 diabetes (T2DM) management, with attention to updating and personalizing recommendations from recent diabetes practice guidelines issued by cardiology societies.

Recent Findings

T2DM management has shifted towards cardiometabolic outcome improvement rather than purely glycemic control. According to large clinical trials, sodium-glucose cotransporter-2 inhibitors showed robust results in reducing heart failure (HF) hospitalization and chronic kidney disease (CKD) progression, while glucagon-like peptide-1 receptor agonists demonstrated the largest effects on HbA1c reduction, weight loss, and atherosclerotic cardiovascular disease outcomes prevention, including stroke.

Summary

Considering the distinct features of these new cardiometabolic agents, initial selection of therapy should be targeted to each individual patient, with consideration of combination therapy for the highest risk patients. Moreover, future studies should investigate the addition of obesity-predominant risk, in conjunction with coronary artery disease, stroke, CKD, and HF, as a new influential indicator for choosing the optimal cardiometabolic agent.

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  1. Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Diseases, Blalock 524D1 JHH 600 N Wolfe St, Baltimore, MD, 21287, USA

    Kunal K. Jha, Rishav Adhikari, Erfan Tasdighi, Ngozi Osuji, Tanuja Rajan & Michael J. Blaha

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Dr. Blaha Grants: NIH, FDA, AHA, Amgen, Novo Nordisk, Bayer. Advisory Boards: Amgen, Novartis, Novo Nordisk, Bayer, Roche, 89Bio, Kaleido, Inozyme, Agepha. Consulting: Kowa, emocha

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Jha, K.K., Adhikari, R., Tasdighi, E. et al. Transitioning to GLP-1 RAs and SGLT2 Inhibitors as the First Choice for Managing Cardiometabolic Risk in Type 2 Diabetes. Curr Atheroscler Rep 24, 925–937 (2022). https://doi.org/10.1007/s11883-022-01066-y

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