Novel pharmacological therapy in type 2 diabetes mellitus with established cardiovascular disease: Current evidence

Abstract

Cardiovascular diseases (CVDs) remain the leading cause of death in the world and in most developed countries. Patients with type 2 diabetes mellitus (T2DM) suffer from both microvascular and macrovascular diseases and therefore have higher rates of morbidity and mortality compared to those without T2DM. If current trends continue, the Center for Disease Control and Prevention estimates that 1 in 3 Americans will have T2DM by year 2050. As a consequence of the controversy surrounding rosiglitazone and the increasing prevalence of diabetes and CVDs, in 2008 the Food and Drug Administration (FDA) established new expectations for the evaluation of new antidiabetic agents, advising for pre and, in some cases, post-marketing data on major cardiovascular events. As a direct consequence, there has been a paradigm shift in new antidiabetic agents that has given birth to the recently published American Diabetes Association/European Association for the Study of Diabetes consensus statement recommending sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon like peptide-1 receptor agonists (GLP-1RA) in patients with T2DM and established CVD. As a result of over a decade of randomized placebo controlled cardiovascular outcome trials, the aforementioned drugs have received FDA approval for risk reduction of cardiovascular (CV) events in patients with T2DM and established CV disease. SGLT2i have been shown to have a stronger benefit in patients with congestive heart failure and diabetic kidney disease when compared to their GLP-1RA counterparts. These benefits are not withstanding additional considerations such as cost and the multiple FDA Black Box warnings. This topic is currently an emerging research area and this mini-review paper examines the role of these two novel classes of drugs in patients with T2DM with both confirmed, and at risk for, CVD.

An Exploratory Research of 18 Years on the Economic Burden of Diabetes for the Romanian National Health Insurance System

“…As the number of newly diagnosed patients increases annually and medication from new structural classes and chemical molecules appear [18], but at a higher cost, the funds required also increase [31,41,42]. Between 1 July 2007 and 31 December 2008, a national programme assessing people's health status was implemented.…”

Bone health in diabetes and prediabetes

“…Glucagon-like peptide-1 (GLP-1) receptor agonists (RA): GLP-1 RAs (liraglutide, exenatide, lixisenatide, dulaglutide, semaglutide) are recommended as the best choice for a second agent when combination treatment is needed to achieve glycemic control in patients with T2D in whom atherosclerotic cardiovascular disease, heart failure, or chronic kidney disease predominates[8,183]. By activating the GLP-1 receptor, GLP-1 RAs slow gastric emptying, suppress glucagon secretion while also stimulating glucose-induced insulin secretion[192]. These effects result in the suppression of hepatic gluconeogenesis and increased peripheral glucose disposal.…”

Glucagon-Like Peptide-1: A Focus on Neurodegenerative Diseases

“…Plasticity of GLP-1 action at molecular level is mirrored also in different tissues like the cardiac compartment and the brain. GLP-1 plays a pivotal role preventing cardiovascular disorders, which makes GLP-1 and its analogs a great resource in the treatment of these diseases (Pozo et al, 2019). GLP-1 is also involved in the reduction of the oxidative stress, in the regulation of autophagy, and in the modulation of central nervous system (CNS) pathways with protective functions and elicitation of anti-inflammatory signaling (Li et al, 2009).…”