Hormonal
For adults with type 2 diabetes and established atherosclerotic cardiovascular disease or high risk, glucagon-like peptide 1 receptor agonists (GLP1RAs) or sodium glucose cotransporter 2 inhibitors (SGLT2is) should be initiated as first-line therapy regardless of baseline HbA1c levels to reduce major adverse cardiovascular events.
If you have type 2 diabetes and heart disease or high heart risk, ask your doctor about GLP-1 agonists (like semaglutide) or SGLT-2 inhibitors (like empagliflozin). These drugs protect your heart and kidneys and are recommended even if your blood sugar numbers look okay. They are often more effective for long-term health than older drugs like metformin alone, though insurance coverage can be a hurdle.
In people with established atherosclerotic cardiovascular disease or risk factors for atherosclerotic cardiovascular disease, a GLP1RA or SGLT2i with known cardiovascular benefit should be started, regardless of levels of HbA1c or background glucose lowering treatments.
Why this rating
Based on multiple large-scale randomized controlled trials (CVOTs) showing significant hazard ratios for major adverse cardiovascular events.
Source
Advances in the management of type 2 diabetes in adults
Rodolfo J. Galindo et al. · BMJ Medicine · 2023
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