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Antihyperglycemic drugs and cardiovascular outcomes in type 2 diabetes

Om P Ganda1

  • 1Clinical Research and Adult Diabetes Sections, Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA.

Cleveland Clinic Journal of Medicine
|May 14, 2016
PubMed

Insights

Intensive glycemic control in diabetes shows a complex link to cardiovascular outcomes. Further research is needed to confirm the cardiovascular safety of glucose-lowering agents and their impact on mortality.

Area of Science:

  • Endocrinology
  • Cardiology
  • Pharmacology

Background:

  • The relationship between intensive glycemic control and cardiovascular (CV) outcomes in diabetes is complex and debated.
  • While glucose-lowering agents prevent microvascular complications and reduce ischemic events, one trial showed increased CV mortality with active treatment.

Purpose of the Study:

  • To address unanswered questions regarding the CV safety of specific glucose-lowering agents.
  • To investigate the mechanisms underlying the effects of these agents on CV events.
  • To highlight the need for long-term randomized controlled trials (RCTs) comparing CV safety against active comparators.

Main Methods:

  • Review of existing clinical trial data on glycemic control and CV outcomes in diabetes.
  • Analysis of reported cardiovascular safety data for various glucose-lowering medications.
  • Emphasis on the design requirements for future long-term randomized controlled trials (RCTs).

Main Results:

  • Established benefits of glucose-lowering agents in preventing microvascular complications and ischemic events.
  • An unexplained increase in CV-associated mortality and total deaths observed in one major glycemic-control trial.
  • Ongoing trials are expected to confirm CV benefits of certain sodium-glucose cotransporter-2 inhibitors.

Conclusions:

  • The cardiovascular safety of specific glucose-lowering agents requires further investigation.
  • Long-term randomized controlled trials (RCTs) are crucial to definitively establish CV safety profiles.
  • Confirmation of cardiovascular benefits for certain agents, like sodium-glucose cotransporter-2 inhibitors, is pending further research.

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