Weight-beneficial agents should be considered in patients, particularly obese patients, who fail to reach glycemic targets on metformin therapy. We propose the following treatment choices based on potential weight benefit and blood glucose increment: long-acting GLP-1 agonists (liraglutide), DPP-4 inhibitors, bile acid sequestrants, amylin analogs, and basal insulin for patients with elevated fasting plasma glucose; and short-acting (exenatide) or long-acting GLP-1 agonists, amylin analogs, DPP-4 inhibitors, acarbose, and bile acid sequestrants for patients with elevated postprandial glucose. The weight-sparing effects of insulin detemir, notably in patients with high body mass index, should also be considered when initiating insulin therapy.

No abstract

No abstract

peptide-1 (GLP-1), may offer some benefits, but, as with the other therapies, data are limited. GLP-1s preserve cardiac function and structure, decrease inflammation, improve glucose metabolism, increase weight loss, reduce blood pressure, and reduce atherosclerotic lesions. Trials are ongoing with these agents.Prof. Fisher concluded that among the antidiabetic therapies, metformin is probably safe for patients with diabetes and HF while the glitazones are not and the DPP-4 inhibitors are also possibly unsafe. As for the SGLT2 inhibitors and GLP-1 receptor agonists, it is too soon to tell.

No abstract