I nsulin resistance and type 2 diabetes mellitus (DM) are highly prevalent conditions among participants in cardiac rehabilitation (CR). 1 Diabetes is associated with a cluster of cardiovascular disease (CVD) risk factors including abdominal obesity, hypertension, and dyslipidemia. More than 34 million individuals have DM and, yet, one in four, including some patients with CVD, are undiagnosed. 2,3 Cardiac rehabilitation provides a unique opportunity to ensure that individuals are optimally managed from both a medical and lifestyle perspective. 4 The core components of CR including weight management, prescribed physical activity, and dietary counseling are all integral to the longterm care of individuals with DM. 5 Moreover, optimizing medical therapy is an important aspect in the care of participants in CR. Some classes of antihyperglycemic agents not only help achieve glycemic control but have also been found to reduce incident hospitalizations for congestive heart failure (HF), decrease macrovascular disease risk, and provide significant weight loss. 6 Thus, DM medication management based on CVD risk factors and mitigation of hypoglycemia risk are critical aspects of managing patients who attend CR.The purpose of this article was to review medications that are generally described as novel antihyperglycemic agents, as well as discuss traditional DM medications. A particular focus of the review was on the relevance and pertinent consideration of these antihyperglycemic medications for individuals participating in CR.
REDUCING CARDIOVASCULAR RISK IN NEW ANTIDIABETIC THERAPIESDue to the increased CVD risk among individuals with DM, the US Food and Drug Administration (FDA) and European Medicines Agency mandate that all new DM drugs demonstrate CVD safety. This mandate was established in response to the evidence linked to the use of rosiglitazone, a thiazolidinedione antidiabetic drug that was found to be associated with a significant increase in myocardial infarction (MI) and death from cardiovascular causes. 7 Thus, in 2008, the FDA specifically recommended that any new DM medication should demonstrate CVD safety. 8,9 Further, it was recommended that trials should focus on high-risk populations, for example, those with advanced age, renal impairment, or peripheral vascular disease and include data on long-term follow-up. As these medications were studied for CVD safety, some antihyperglycemic agents have been found to provide cardiovascular benefit in both primary and secondary prevention. In particular, these newer agents have demonstrated efficacy in individuals with a diagnosis of HF. 6 Additionally, these agents are associated with significant weight loss, which is particularly relevant in the CR setting as >80% of participants are overweight. 10
NOVEL DIABETES MEDICATIONS
INCRETIN MEDICATIONS: DIPEPTIDYL PEPTIDASE-4 INHIBITORS AND GLUCAGON-LIKE PEPTIDE-1 RECEPTOR AGONISTSCare for individuals with DM has been transformed beyond medications affecting insulin release and sensitivity. Glucagon-like peptide-1 rec...
