[Diabetes Mellitus Type 2: Recent Publications and New Drugs]

Area of Science:

• Endocrinology and Metabolism
• Cardiology
• Pharmacology

Background:

• Type 2 diabetes mellitus (T2DM) patients, especially those at high cardiovascular risk, require glucose-lowering agents with proven cardiovascular safety.
• Several new classes of glucose-lowering agents have been evaluated in placebo-controlled cardiovascular outcomes trials (CVOTs) since 2013.

Purpose of the Study:

• To assess the cardiovascular safety and efficacy of novel glucose-lowering agents in patients with T2DM and high cardiovascular risk.
• To compare the cardiovascular outcomes of glucagon-like peptide 1 (GLP-1) receptor agonists, sodium-glucose cotransporter-2 (SGLT-2) inhibitors, and dipeptidyl peptidase-4 (DPP-4) inhibitors.

Main Methods:

• Review of placebo-controlled cardiovascular outcomes trials (CVOTs) for new glucose-lowering agents, including GLP-1 receptor agonists (liraglutide, semaglutide), SGLT-2 inhibitors (empagliflozin, canagliflozin), and DPP-4 inhibitors (saxagliptin, alogliptin, sitagliptin).
• Analysis focused on the primary composite outcome: nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death.

Main Results:

• GLP-1 receptor agonists (liraglutide, semaglutide) and SGLT-2 inhibitors (empagliflozin, canagliflozin) demonstrated statistically significant reductions in the primary composite cardiovascular outcome.
• DPP-4 inhibitors (saxagliptin, alogliptin, sitagliptin) did not show statistically significant differences in major cardiovascular events compared to placebo.

Conclusions:

• For patients with established cardiovascular disease and inadequate glycemic control on metformin, GLP-1 receptor agonists and SGLT-2 inhibitors are preferred for intensifying diabetes therapy due to proven cardiovascular benefits.
• DPP-4 inhibitors represent a well-tolerated and safe oral glucose-lowering option for patients needing an additional therapy, although without demonstrated cardiovascular risk reduction.