Hormonal
GLP-1 agonists (semaglutide, liraglutide) reduce nephropathy incidence and improve microvascular function beyond epidemiological expectations, but may increase early retinopathy-related events due to rapid HbA1c reduction.
GLP-1 agonists like semaglutide and liraglutide offer significant protection against kidney disease (nephropathy) and improve microvascular function in diabetic patients with heart disease. However, because they lower blood sugar rapidly, they can temporarily increase the risk of eye problems (retinopathy) due to osmotic shifts. Patients with existing eye disease should be monitored closely when starting these medications.
Interestingly, in the SUSTAIN-6 and LEADER trials, the GLP-1 agonists semaglutide and liraglutide, respectively, reduced the incidence of nephropathy [60, 64]... Paradoxically, the LEADER and SUSTAIN-6 studies also demonstrated an increased incidence of retinopathy-related events [60, 64]—suggested to be due to the dramatic reduction in HbA1c in the early phases of these trials with osmotic shifts...
Why this rating
Based on large, qualified meta-analyses and major CV outcome trials (SUSTAIN-6, LEADER).
Source
Diabetes, cardiovascular disease and the microcirculation
W. David Strain et al. · Cardiovascular Diabetology · 2018
DOI 10.1186/s12933-018-0703-2
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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
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