Glucose-Lowering Drugs To Reduce Cardiovascular Risk In Type 2 Diabetes

Glucose-Lowering Drugs to Reduce Cardiovascular Risk in Type 2 DiabetesThe attainment of glycemic targets and comprehensive reduction in risk factors for cardiovascular disease are important to the reduction in microvascular and macrovascular diabetic complications, respectively.In men and nonpregnant women with diabetes who are otherwise healthy, most professional societies recommend a glycated hemoglobin level below 6.5% or 7.0%. However, glycemic targets should be individualized according to other factors (e.g., risk of hypoglycemia, coexisting conditions, and patient preferences).Along with lifestyle recommendations, the standard initial pharmacologic treatment used in patients with type 2 diabetes is metformin. Assessment of cardiovascular disease status and risk factors is critical in guiding the selection of additional glucose-lowering therapy to reduce the risk of cardiovascular events.The treatment of patients with diabetes and established cardiovascular disease (and in selected patients at high risk for cardiovascular disease) should include a glucose-lowering medication with demonstrated cardiovascular benefit, including specific agents from the glucagon-like peptide-1 (GLP-1) receptor agonist or sodium-glucose cotransporter type 2 (SGLT2) inhibitor classes.For patients with type 2 diabetes who have a history of heart failure with reduced ejection fraction, SGLT2 inhibitors with demonstrated benefit in heart failure are recommended.In patients with type 2 diabetes and established cardiovascular disease (or in those with a high risk of cardiovascular disease) in whom glycemic goals are not achieved with metformin, agents from the GLP-1 receptor agonist or SGLT2 inhibitor classes with demonstrated cardiovascular benefit constitute the recommended treatment.