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Emerging glucose-lowering therapies: a guide for cardiologists
  1. Gaurav S Gulsin1,
  2. Matthew P M Graham-Brown1,
  3. Melanie J Davies2,
  4. Gerry P McCann1
  1. 1Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
  2. 2Diabetes Research Centre, University of Leicester, Leicester, UK
  1. Correspondence to Professor Gerry P McCann, Department of Cardiovascular Sciences, University of Leicester, Leicester LE1 7RH, UK; gpm12{at}leicester.ac.uk

Abstract

In recent large-scale cardiovascular outcome trials, two new classes of glucose-lowering medications—sodium glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1RAs)—demonstrated cardiovascular benefits in adults with type 2 diabetes mellitus (T2DM). These findings have prompted growing optimism among clinicians regarding the potential for these agents to reduce the burden of cardiovascular disease in people with T2DM. GLP-1RAs and SGLT2i are now advocated as second-line agents in European and US guidelines for management of both hyperglycaemia and for primary prevention of cardiovascular disease in people with T2DM. Given the high prevalence of T2DM in patients with cardiovascular disease, cardiologists will increasingly encounter these agents in routine clinical practice. In this review, we summarise evidence from cardiovascular outcome trials of GLP-1RAs and SGLT2i, give practical advice on prescribing and detail safety considerations associated with their use. We also highlight areas where further work is needed, giving details on active clinical trials. The review aims to familiarise cardiologists with these emerging treatments, which will be increasingly encountered in clinical practice, given the expanding representation of T2DM in patients with cardiovascular disease. Whether these drugs will be initiated by cardiologists remains to be determined.

  • Type 2 diabetes mellitus
  • sodium glucose co-transporter-2 inhibitors
  • glucagon-like peptide-1 receptor agonists
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Footnotes

  • Contributors GSG and GPM conceived the idea for the review. GSG and MPMGB drafted the manuscript, which was critically reviewed by GPM and MJD. All authors approved the final submission.

  • Funding GSG is funded through a British Heart Foundation Clinical Research Training Fellowship (CRTF 32190). GPM is funded through a National Institute for Health Research (NIHR) Research Professorship (RP-2017-08-ST2-007). All authors receive support from the NIHR Leicester Biomedical Research Centre and the NIHR Leicester Clinical Research Facility.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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