Impact of glucose-lowering drugs on cardiovascular disease in type 2 diabetes

Ele Ferrannini, Ralph A Defronzo

Research output: Contribution to journalArticle

154 Scopus citations

Abstract

Type 2 diabetes mellitus (T2DM) is characterized by multiple pathophysiologic abnormalities. With time, multiple glucose-lowering medications are commonly required to reduce and maintain plasma glucose concentrations within the normal range. Type 2 diabetes mellitus individuals also are at a very high risk for microvascular complications and the incidence of heart attack and stroke is increased two-to three-fold compared with non-diabetic individuals. Therefore, when selecting medications to normalize glucose levels in T2DM patients, it is important that the agent not aggravate, and ideally even improve, cardiovascular risk factors (CVRFs) and reduce cardiovascular morbidity and mortality. In this review, we examine the effect of oral (metformin, sulfonylureas, meglitinides, thiazolidinediones, DPP4 inhibitors, SGLT2 inhibitors, and α-glucosidase inhibitors) and injectable (glucagon-like peptide-1 receptor agonists and insulin) glucose-lowering drugs on established CVRFs and long-term studies of cardiovascular outcomes. Firm evidence that in T2DM cardiovascular disease can be reversed or prevented by improving glycaemic control is still incomplete and must await large, long-term clinical trials in patients at low risk using modern treatment strategies, i.e. drug combinations designed to maximize HbA<inf>1c</inf> reduction while minimizing hypoglycaemia and excessive weight gain.

Original languageEnglish (US)
Pages (from-to)2288-2296
Number of pages9
JournalEuropean Heart Journal
Volume36
Issue number34
DOIs
StatePublished - Sep 7 2015

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Keywords

  • Cardiovascular disease
  • Cardiovascular risk
  • Glucose-lowering drugs
  • Type 2 diabetes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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