Facts to remember: What is based on the evidence in atherosclerosis prevention in type 2 diabetes?

Overview

The following article briefly summarizes the results of all studies that have shown benefit in preventing the develop­ment of cardiovascular disease in patients with diabetes. The UKPDS study showed a benefit of initial treatment with metformin in preventing myocardial infarction and cardiovascular mortality. Studies with empagliflozin and canagliflozin have shown a benefit of additional treatment with SGLT2 inhibitors in the prevention of major cardiovascular events. Likewise, additional treatment with GLP-1 receptor agonists was beneficial in preventing major cardiovascular events, as shown in studies with liraglutide, semaglutide, albiglutide and dulaglutide. Based on the results of the above-mentioned studies, most therapeutic recommendations agree on the following points: metformin should be used as the first-line drug of choice in patients with type 2 diabetes. GLP-1 receptor agonists or SGLT2 inhibitors are the most appropriate second-choice drugs to combine with metformin. These groups of drugs should be included in any multidrug combinations of antidiabetic therapy. The choice between these two drug groups of depends on comorbidities, potential side effects, and patients‘ preference. GLP-1 receptor agonists are appropriate when atherosclerotic involvement of the coronary, cerebral, or peripheral arteries predominates. SGLT2 inhibitors are appropriate in concomitant heart failure as well as in chronic kidney disease.