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Glucose Lowering Drug to Reduce Cardiovascular Risk in Type 2 Diabetes

Glucose Lowering Drug to Reduce Cardiovascular Risk in Type 2 Diabetes

A recent clinical practice review article published on 1 April 2021 in the New England Journal of Medicine (NEJM) presents evidence supporting various treatment strategies aimed to reduce the cardiovascular disease burden in patients with type 2 diabetes mellitus (T2DM). Treatment approaches discussed include the use of glycaemic targets, modification of lifestyle and the use of glucose-lowering medication. The publication provides an up-to-date review of the evidence for cardiovascular risk reduction of various glucose-lowering drugs. Drawing in on clinical evidence which has informed recommendations in most major guidelines globally, the author recommends for patients with T2DM and established atherosclerotic cardiovascular disease, whose glycaemic goals are not met with metformin, the prescribing of a glucose-lowering agent that has been shown to have cardiovascular benefit, which currently include agents in the SGLT2 inhibitor and the GLP-1 receptor agonist classes.

The article began by presenting a case study of a patient with type 2 diabetes of long duration and established atherosclerotic cardiovascular disease, highlighting a common clinical problem, and concludes with author’s recommendations following review of clinical evidence and formal guidelines.

  • For T2DM patients with established atherosclerotic cardiovascular disease (or at high risk for CVD): Add either GLP-1 receptor agonist or SGLT2 inhibitor with demonstrated cardiovascular benefit
  • For T2DM patients with a history of heart failure with reduced ejection fraction: Add SGLT2 inhibitor with demonstrated benefit in heart failure to regimen
  • For T2DM patients with chronic kidney disease: Add SGLT2 inhibitor with proven renal benefit

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Editorial Board

Image
Dr. Salvatore A. De Cosmo's image

Dr. Salvatore A. De Cosmo

Head of Unit of Internal Medicine and Endocrinology, Scientific Institute “Casa Sollievo della Sofferenza” San Giovanni, Rotondo, Italy
,
Image
Dr. Juan José Gorgojo Martínez's image

Dr. Juan José Gorgojo Martínez

Head of Department of Endocrinology and Nutrition, University Hospital Fundación, Alcorcon, Madrid, Spain
,
Image
Dr. Patrick Holmes' image

Dr. Patrick Holmes

General Practitioner, St. George's Medical Practice, Darlington, UK

Editorial Board

Image
Dr. Salvatore A. De Cosmo's image

Dr. Salvatore A. De Cosmo

Head of Unit of Internal Medicine and Endocrinology, Scientific Institute “Casa Sollievo della Sofferenza” San Giovanni, Rotondo, Italy
Image
Dr. Juan José Gorgojo Martínez's image

Dr. Juan José Gorgojo Martínez

Head of Department of Endocrinology and Nutrition, University Hospital Fundación, Alcorcon, Madrid, Spain
Image
Dr. Patrick Holmes' image

Dr. Patrick Holmes

General Practitioner, St. George's Medical Practice, Darlington, UK

Publication under Spotlight

Glucose-Lowering Drugs to Reduce Cardiovascular Risk in Type 2 Diabetes

N Engl J Med.

2021;384(13):1248-1260.

Authors: Rita R Kalyani

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