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June 14, 2021
New Guidelines for Selection of Glucose-lowering Medication in Type 2 Diabetes: The American Diabetes Association Standards of Medical Care in Diabetes-2021 recommend selection of glucose-lowering medications based on patient factors. A GLP-1 receptor agonist or SGLT-2 inhibitor with proven benefit for the patient’s specific comorbidity is recommended independent of baseline A1c, A1c goal, or metformin use. For patients with, or at risk for, atherosclerotic cardiovascular disease either a GLP-1 receptor agonist or SGLT-2 inhibitor is recommended. For heart failure with reduced ejection fraction, an SGLT-2 inhibitor is recommended. For patients with type 2 diabetes (T2D) and chronic kidney disease (CKD) with albuminuria, an SGLT-2 inhibitor is preferred, though a GLP-1 receptor agonist could be used if SGLT-2 is not tolerated. For T2D patients with CKD and no albuminuria, either a GLP-1 receptor agonist or SGLT-2 inhibitor is recommended.
November 15, 2019
Semaglutide: The First Oral GLP-1 Receptor Agonist: In September 2019, the U.S. Food and Drug Administration (FDA) approved semaglutide (Rybelsus, Novo Nordisk) for treatment of type 2 diabetes mellitus (T2DM). The glucacon-like-peptide-1 (GLP-1) receptor agonists are a recommended second-line, add-on therapy to metformin for patients with T2DM who are at high-risk of atherosclerotic cardiovascular (CV) events. However, agents with proven CV benefit should be used preferentially. In the PIONEER 6 trial, oral semaglutide did not significantly reduce the risk of major CV events, but it did significantly reduce CV and all-cause mortality. Oral semaglutide is a welcome option for treatment of T2DM in patients who would benefit from weight loss and are at high-risk of atherosclerotic CV disease but who prefer an oral dosage form.
May 17, 2019
Pharmacotherapy Recommendations for Patients with Diabetes Mellitus and Cardiovascular or Chronic Kidney Disease: The 2019 guideline update for management of diabetes mellitus strengthened the recommendations for specific agents in the setting of coexisting chronic disease states such as atherosclerotic cardiovascular disease (ASCVD), heart failure (HF), and chronic kidney disease (CKD). These recommendations incorporate recently published literature regarding the cardiovascular and renal benefit of agents in the glucagon-like peptide-1 (GLP-1) and sodium-glucose cotransportor-2 inhibitor (SLGT2i) classes. In patients with established ASCVD, an agent with proven cardiovascular benefit should be utilized. In patients with HF, SGLT2i can provide additional benefit. In patients with established CKD, canagliflozin can decrease risk of progression to end-stage renal disease. These agents should be considered first line add-on therapy to metformin and lifestyle changes in patients who need additional glycemic control.
May 10, 2019
Beneficial Cardiorenal Effects of SGLT2 Inhibitors: Type 2 diabetes (T2D) is a significant risk factor for additional health problems, such as chronic kidney disease (CKD) and cardiovascular events. Current guidelines suggest use of an SGLT2 inhibitor or GLP-1 agonist for T2D patients with established atherosclerotic cardiovascular disease (ASCVD) or CKD ...