Desirable Side Effects of Antidiabetics
The days when diabetology was a field solely focused on normalizing blood sugar levels are long gone. Today, the approach in diabetology increasingly prioritizes influencing the patient's overall life prognosis, particularly reducing cardiovascular risk. What can be the desirable side effects of the main groups of antidiabetics that are not related to merely lowering glucose levels?
Metformin
Metformin is not only the fundamental medication in the treatment of type 2 diabetes mellitus (DM), but it also shows positive effects on a range of malignancies. According to some studies, it reduces the occurrence of tumors in patients with DM by up to 40% in primary prevention, and it is also considered advantageous as an adjuvant therapy in the treatment of already diagnosed cancer diseases.
SGLT2 Inhibitors (Gliflozins)
Sodium-glucose cotransporter 2 (SGLT2) inhibitors have quickly gained popularity. They demonstrably reduce the risk of cardiovascular events, particularly the onset of heart failure and its worsening, including hospitalizations for heart failure, both through their direct diuretic effects and various more complex indirect mechanisms. At this level, the renoprotective effect of gliflozins is also described. The increased glucose excretion caused by gliflozins has, besides the desired diuretic effect, an impact on weight reduction, as the prevention of glucose reabsorption in the kidney tubules creates a calorie deficit. Lastly, the use of gliflozins leads to a decrease in blood pressure.
Empagliflozin, unlike other representatives of this group, has been shown to reduce overall and cardiovascular mortality in a high-risk population of diabetics. According to the results of the large clinical study EMPA-REG OUTCOME, empagliflozin, especially in combination with metformin, not only compensates for DM2 very well but also significantly reduces the risk of cardiovascular events and heart failure. The renal benefits, reducing the need for dialysis by up to 50%, are also markedly positive.
GLP-1 Analogues (Incretins)
Treating diabetes with analogues of glucagon-like peptide 1 (GLP-1) is beneficial for patients with concurrent overweight or obesity. These medications effectively reduce food intake and thus body weight, to the extent that liraglutide, administered at 3 mg/day, is classified among anti-obesity drugs that any specialist can prescribe without restrictions. (For comparison, in diabetic indications, the maximum recommended dose is 1.8 mg/day.)
GLP-1 analogues are also suitable for treating patients with diabetes and an increased risk of cardiovascular events. Liraglutide, semaglutide, and albiglutide have been shown to reduce the risk of significant cardiac events in studies, most likely by improving insulin resistance, reducing weight and blood pressure, improving the lipid profile, and also through direct effects on the heart and vascular endothelium.
Conclusion
The primary goal of well-managed treatment for diabetics naturally remains the best possible glycemic control. However, it is very desirable to view the patient and his condition holistically and based on this, choose an antidiabetic that also helps treat potential comorbidities, influence body weight, and reduce cardiovascular atherosclerotic risk or the risk of renal and cardiac failure development.
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