Implications of Cardiovascular Outcomes Trials in Type 2 Diabetes for Primary Care

Patients with type 2 diabetes (T2D) are at a greater risk of cardiovascular (CV) morbidity and mortality than their counterparts without diabetes. Worsening glycemic control is associated with increasing risk of CV events and mortality, but glycemic control alone does not appear sufficient to improve CV outcomes. Furthermore, some glucose-lowering drugs have been associated with an increased risk of CV events. As a result, the US Food and Drug Administration (FDA) issued guidance in 2008 for the investigation of CV risk with new diabetes therapies. Numerous CV outcomes trials have since been initiated for drugs in the dipeptidyl peptidase 4 (DPP-4) inhibitors, sodiumglucose cotransporter-2 (SGLT-2) inhibitors, and glucagon-like peptide-1 receptor agonist (GLP-1 RA) classes. CV safety has been confirmed for a number of drugs. More recently, CV benefits have been shown for some SGLT-2 inhibitors and GLP-1 RAs. Primary care physicians should consider medications that can lower CV risk alongside favorable efficacy and safety profiles for treatment of patients with T2D at high CV risk.