Type 2 diabetes and cardiovascular disease: risk reduction and early intervention

ABSTRACT

People with type 2 diabetes (T2D) have a higher risk of cardiovascular (CV) disease (CVD) than those without. This increased risk begins with pre-diabetes, potentially 7–10 years before T2D is diagnosed. Selecting medication for patients with T2D should focus on reducing the risk of CVD and established CVD. Within the last decade, several antihyperglycemic agents with proven CV benefit have been approved for the treatment of hyperglycemia and for the prevention of primary and secondary CV events, including glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter-2 inhibitors. T2D treatment guidelines recommend that an antihyperglycemic agent with proven CV benefit should be used after metformin in patients with high risk of or established CVD, regardless of glycated hemoglobin levels. Despite the availability of antihyperglycemic agents with proven CV benefit, and guidelines on when to use them, less than one in four patients with T2D and CVD receive this type of therapy. These findings suggest a potential gap between current recommendations and clinical practice. This article reviews the approved agents with CV indications, with a focus on injectable GLP-1RAs, and their place in the T2D treatment paradigm according to current guidelines. We aim to provide primary healthcare providers with in-depth information on subsets of patients who would benefit from this type of therapy and when it should be initiated, taking into consideration safety and tolerability and other disease factors. An individualized treatment approach is increasingly recommended in the management of T2D, employing a shared decision-making strategy between patients and healthcare professionals.

Video Abstract

© 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group

KEYWORDS:

• Cardiovascular disease
• incretin therapy
• antidiabetic drug
• diabetes complications
• type 2 diabetes

List of abbreviations

Table

Acknowledgments

Under the direction of the authors, medical writing and editorial support were provided by Debbie Day of Axis, a division of Spirit Medical Communications Group Ltd. (funded by Novo Nordisk Inc.).

Authorship

The authors were involved with conceptualization, drafting, and/or critically reviewing all drafts during the development of the review article, and all authors provided their final approval for submission.

Disclosure of any financial/other conflicts of interest

Debbie Hinnen has attended advisory boards and served on speakers’ bureaus for Boehringer Ingelheim, Eli Lilly and Co., Janssen Pharmaceuticals, Novo Nordisk, and Sanofi. Davida Kruger has attended advisory boards for Eli Lilly and Co., Novo Nordisk, and Sanofi, and served on speakers’ bureaus for AstraZeneca, Eli Lilly and Co., Janssen Pharmaceuticals, and Novo Nordisk. Melissa Magwire has attended advisory boards and acted as a consultant for Boehringer Ingelheim, Eli Lilly and Co., and Novo Nordisk.

The authors have no other 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 apart from those disclosed.

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

Declaration of funding

This article was supported by Novo Nordisk Inc.; the company was provided with the opportunity to perform a medical accuracy review.

Data availability statement

Data sharing not applicable to this article as no datasets were generated or analyzed during the current study.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/00325481.2022.2126235