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Diabetes Management and Cardiovascular Risk: Are SGLT-2 Inhibitors the Safest?
Arthur L M Swislocki1,2, Ishwarlal Jialal1,3
11 Medical Service , Department of Veterans Affairs Northern California Health Care System, Sacramento, California.
Abstract:
For five millennia, diabetes management has focused on controlling blood sugar and efforts to minimize the complications of this disease have depended on normalizing glucose. Since the 1970's, however, a growing awareness of the adverse effect of hypoglycemic agents on cardiac health has led to an increasing focus on the effect of diabetes management on cardiac risk. This was brought into focus in the early years of this century with issues around rosiglitazone and resulted in the United States Food and Drug Administration, mandating that new drug applications for diabetes include documentation of no adverse effect on cardiac health. We have recently reported on the potential benefit of SGLT-2 inhibitors in terms of glucose control; recent data suggesting a specific cardiac benefit of this class of agent have obligated us to update our understanding of this class of drugs. This review focuses, in general, on the increasing awareness of the effects of diabetes medications on cardiac health and, more specifically, on newer agents, including incretin-based therapies and SGLT-2 inhibitors.
Insights
Diabetes management now prioritizes cardiac health alongside blood sugar control. Newer medications like SGLT-2 inhibitors and incretin-based therapies show promise for improving cardiovascular outcomes in diabetic patients.
Area of Science:
- Cardiology
- Endocrinology
- Pharmacology
Background:
- Historically, diabetes management centered on glycemic control to prevent complications.
- Concerns regarding cardiovascular risks associated with certain hypoglycemic agents emerged in the late 20th century.
- Regulatory bodies now mandate cardiac safety assessments for new diabetes medications.
Purpose of the Study:
- To review the evolving understanding of diabetes medications' impact on cardiac health.
- To specifically examine the cardiovascular effects of newer antidiabetic agents, including incretin-based therapies and SGLT-2 inhibitors.
Main Methods:
- Literature review focusing on studies evaluating the cardiovascular effects of diabetes medications.
- Analysis of recent data on incretin mimetics and sodium-glucose cotransporter-2 (SGLT-2) inhibitors.
- Synthesis of evidence regarding regulatory requirements for cardiac safety.
Main Results:
- Growing evidence links diabetes medication choices to cardiovascular risk.
- Sodium-glucose cotransporter-2 (SGLT-2) inhibitors demonstrate potential cardiovascular benefits beyond glucose lowering.
- Incretin-based therapies are also under scrutiny for their cardiac impact.
Conclusions:
- Diabetes management must integrate cardiovascular risk assessment and mitigation strategies.
- Emerging drug classes offer new avenues for managing both diabetes and cardiac health.
- Continued research is crucial to fully elucidate the long-term cardiovascular profiles of novel antidiabetic agents.
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