Hormonal
For patients with type 2 diabetes and established atherosclerotic cardiovascular disease (ASCVD), sodium-glucose cotransporter 2 (SGLT2) inhibitors or glucagon-like peptide 1 (GLP-1) receptor agonists with proven cardiovascular benefit are recommended as part of glycemic management, regardless of baseline HbA1c.
If you have type 2 diabetes and a history of heart disease (like a heart attack or stroke), your doctor should prioritize medications that protect your heart, specifically SGLT2 inhibitors (like empagliflozin) or GLP-1 agonists (like liraglutide), even if your blood sugar is already reasonably controlled. This is a major shift from older guidelines that focused only on lowering blood sugar numbers.
Among patients with type 2 diabetes who have established ASCVD, SGLT2 inhibitors or GLP-1 receptor agonists with proven cardiovascular benefit are recommended as part of glycemic management (Figs. 2 and 3).
Why this rating
Based on large, multi-year cardiovascular outcomes trials (CVOTs) demonstrating statistical superiority for major adverse cardiac events (MACE) and mortality.
Source
Management of Hyperglycemia in Type 2 Diabetes, 2018. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)
Melanie J. Davies et al. · Diabetes Care · 2018
DOI 10.2337/dci18-0033
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Related findings · Hormonal
- Initial treatment for type 2 diabetes should be a combination of metformin and either an SGLT-2 inhibitor or a GLP-1 receptor agonist to achieve cardiorenal protection, rather than monotherapy or older agents like sulfonylureas.Strong
- For patients with specific monogenic obesity syndromes (leptin deficiency, POMC/PCSK1/LEPR mutations), targeted pharmacotherapy (recombinant leptin or setmelanotide) is highly effective and should be prioritized, unlike in polygenic obesity.Strong
- Continued weekly administration of 2.4 mg subcutaneous semaglutide prevents weight regain and promotes further weight loss in adults with overweight or obesity, whereas switching to placebo results in significant weight regain.Strong
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