title: Impact of glucose-lowering drugs on cardiovascular disease in type 2 diabetes.
abstract: Type 2 diabetes mellitus (T2DM) is characterized by multiple pathophysiologic abnormalities. With time, multiple glucose-lowering medications are commonly required to reduce and maintain plasma glucose concentrations within the normal range. Type 2 diabetes mellitus individuals also are at a very high risk for microvascular complications and the incidence of heart attack and stroke is increased two- to three-fold compared with non-diabetic individuals. Therefore, when selecting medications to normalize glucose levels in T2DM patients, it is important that the agent not aggravate, and ideally even improve, cardiovascular risk factors (CVRFs) and reduce cardiovascular morbidity and mortality. In this review, we examine the effect of oral (metformin, sulfonylureas, meglitinides, thiazolidinediones, DPP4 inhibitors, SGLT2 inhibitors, and α-glucosidase inhibitors) and injectable (glucagon-like peptide-1 receptor agonists and insulin) glucose-lowering drugs on established CVRFs and long-term studies of cardiovascular outcomes. Firm evidence that in T2DM cardiovascular disease can be reversed or prevented by improving glycaemic control is still incomplete and must await large, long-term clinical trials in patients at low risk using modern treatment strategies, i.e., drug combinations designed to maximize HbA1c reduction while minimizing hypoglycaemia and excessive weight gain.
authors.affiliation: Institute of Clinical Physiology, National Research Council (CNR), Pisa, Italy ferranni@ifc.cnr.it.
authors.forename: Ele
authors.initials: E
authors.lastname: Ferrannini
authors.affiliation: Diabetes Division, University of Texas Health Science Center, San Antonio, TX, USA.
authors.forename: Ralph A
authors.initials: RA
authors.lastname: DeFronzo
mesh_terms: D002219:Carbamates / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D003324:Coronary Artery Disease / Q000188:drug therapy / Q000209:etiology; D003510:Cyclohexanes / Q000627:therapeutic use; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000209:etiology; D003925:Diabetic Angiopathies / Q000188:drug therapy* / Q000209:etiology; D054873:Dipeptidyl-Peptidase IV Inhibitors / Q000627:therapeutic use; D065089:Glycoside Hydrolase Inhibitors / Q000627:therapeutic use; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use; D008687:Metformin / Q000627:therapeutic use; D000077715:Nateglinide; D010649:Phenylalanine / Q000031:analogs & derivatives / Q000627:therapeutic use; D010880:Piperidines / Q000627:therapeutic use; D051247:Sodium-Glucose Transport Proteins / Q000037:antagonists & inhibitors; D013453:Sulfonylurea Compounds / Q000627:therapeutic use; D045162:Thiazolidinediones / Q000627:therapeutic use; D016896:Treatment Outcome; D000097789:Glucagon-Like Peptide-1 Receptor Agonists
chemical_list: D002219:Carbamates; D003510:Cyclohexanes; D054873:Dipeptidyl-Peptidase IV Inhibitors; D065089:Glycoside Hydrolase Inhibitors; D007004:Hypoglycemic Agents; D007328:Insulin; D010880:Piperidines; D051247:Sodium-Glucose Transport Proteins; D013453:Sulfonylurea Compounds; D045162:Thiazolidinediones; D000077715:Nateglinide; D010649:Phenylalanine; C072379:repaglinide; D008687:Metformin; D000097789:Glucagon-Like Peptide-1 Receptor Agonists
keywords: Cardiovascular disease; Cardiovascular risk; Glucose-lowering drugs; Type 2 diabetes