Effects of glucose-lowering drugs on cardiovascular outcomes in patients with type 2 diabetes: an update

ABSTRACT

Introduction

Over the last few years, there has been a substantial increase in the data available about the benefits of sodium-glucose cotransporter-2 (SGLT2) inhibitors and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in improving cardiovascular and renal outcomes in patients with type 2 diabetes (T2D). Very little new information is available for the other groups of glucose-lowering drugs.

Areas covered

This brief report summarizes the recent information about the respective benefits of the two newer groups of glucose-lowering drugs and the effects on cardiovascular risk factors that may be involved in these benefits. The articles reviewed were identified by a Medline search.

Expert opinion

Recent guidelines recommend SGLT2 inhibitors or GLP-1 RAs with proven cardiovascular disease benefits as potential first line treatment for patients with T2D and established atherosclerotic cardiovascular disease (ASCVD) or those with high risk of ASCVD or with chronic kidney disease or heart failure. Both groups of drugs have been shown to reduce major adverse cardiovascular events, but the mechanisms vary between them. SGLT2 inhibitors are preferred for the treatment and prevention of heart failure and chronic kidney disease, whereas GLP-1 RAs are more effective in reducing body weight and improving glycemic control in patients with T2D.

KEYWORDS:

• Atherosclerotic cardiovascular disease
• chronic kidney disease
• heart failure
• glucagon-like peptide-1 receptor agonists
• obesity
• sodium-glucose cotransporter-2 inhibitors
• type 2 diabetes

Article highlights

• SGLT2 inhibitors and GLP-1 RAs have been shown to improve cardiovascular and renal outcomes in patients with T2D.

• The benefits can be attributed to effects on cardiovascular risk factors that vary between the two groups of drugs.

• In addition to lowering plasma glucose and HbA1c levels, SGLT2 inhibitors have a diuretic effect and reduce body weight, systolic, and diastolic blood pressure, plasma urate, and triglyceride levels.

• SGLT2 inhibitors are particularly useful for the treatment and prevention of heart failure and chronic kidney disease.

• GLP-1 RAs are more effective in reducing body weight, plasma glucose, HbA1c, and lipid levels.

• GLP-1 RAs have an advantage when weight reduction is a priority and may be preferred in T2D patients with ASCVD, particularly coronary artery disease.

Declaration of interests

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosure

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This manuscript was funded by Research Funding from the Faculty of Medicine, Macau University of Science and Technology.