Many Treatment Choices for Type 2 Diabetes
SOURCE: Palmer SC, Mavridis D, Nicolucci A, et al. Comparison of clinical outcomes and adverse events associated with glucose-lowering drugs in patients with type 2 diabetes: A meta-analysis. JAMA 2016;316:313-324.
The real goals of diabetes treatment are reduction in microvascular (retinopathy, nephropathy, and neuropathy) and macrovascular (myocardial infarction and stroke) endpoints. With that in mind, it should be sobering to review current FDA-approved labeling for antidiabetic meds: “There have been no clinical studies establishing conclusive evidence of macrovascular risk reduction with [insert drug name] or any other anti-diabetic drug.”
A recent large meta-analysis (301 clinical trials) addressed cardiovascular mortality as well as all-cause mortality for the most commonly used antidiabetic drugs (metformin, sulfonylureas, thiazolidinediones, alpha-glucosidase inhibitors, insulin, DPP-4 inhibitors, SGLT-2 inhibitors, and GLP-1 receptor agonists) seeking to discern any differences in cardiovascular events or mortality, as well as safety.
Despite an impressive amount of data, no particular class of agents — as monotherapy or in combination — provided distinct advantages for risk reduction of cardiovascular events or mortality.
Recent cardiovascular safety trials featuring two agents (empagliflozin and liraglutide) challenge the concept that diabetes treatment is ineffectual for cardiovascular risk reduction, but if clinicians believe in “class effects” of medications, it appears dubious that any clear winners will emerge any time soon in the quest for cardiovascular risk reduction.
Despite an impressive amount of data, no particular class of agents — as monotherapy or in combination — provided distinct advantages for risk reduction of cardiovascular events or mortality.
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