scholarly journals Antihyperglycemic drugs that improve cardiovascular outcomes and a model of diabetic cardiomyopathy

2019 ◽  
pp. 18-22
Keyword(s):  
Diabetic Cardiomyopathy ◽  
Disease Process ◽  
Therapeutic Interventions ◽  
Second Line ◽  
Cardiovascular Outcome Trials ◽  
Short Period ◽  
Historical Importance ◽  
Glucagon Like Peptide ◽  
Glucagon Like Peptide 1

Recent cardiovascular outcome trials (CVOTs) have transformed the landscape for the management of type 2 diabetes mellitus. In a remarkably short period of time, national and international guidelines have been overhauled to reflect the remarkable cardiovascular benefits of sodium/glucose linked transporter-2 inhibitors (SGLT2is) and glucagon-like peptide-1 receptor analogues (GLP-1RA) in mitigating cardiovascular risk. Both SGLT2is and GLP-1RAs remain second-line to metformin, reflecting the historical importance of this biguanide antihyperglycemic. In this review, these three very different antihyperglycemics are discussed in the light of CVOT data and of the preclinical data revealing remarkable pleiotropic signaling effects of these drugs. A model of diabetic cardiomyopathy is discussed, and the points of contact that these therapeutic interventions have upon this model may of help in understanding how each can be best targeted in this complex pathophysiological disease process.

scholarly journals Comparative Cardio-Renal Outcomes of Type 2 Diabetes Patients Administered Glucagon-Like Peptide-1 Receptor Agonists: A Network Meta-Analysis

2021 ◽  
Vol 12 ◽  
Author(s):  
Chuanjun Zhuo ◽  
Chongguang Lin ◽  
Chunhua Zhou ◽  
Xiangyang Gao ◽  
Hailin Shao ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Type 2 Diabetes ◽  
Thyroid Carcinoma ◽  
Kidney Function ◽  
Cardiovascular Outcome Trials ◽  
Secondary Outcomes ◽  
Glucagon Like Peptide ◽  
Glucagon Like Peptide 1

Background: Cardio-renal profiles are available from cardiovascular outcome trials of glucagon-like peptide-1 receptor agonists (GLP-1 RAs).Methods: A comprehensive systematic review of Embase, Medline, Web of Knowledge, and CENTRAL databases was conducted. Randomized controlled cardiovascular outcome trials of type 2 diabetes mellitus (T2DM) patients administered GLP-1 RAs were included. The following primary outcomes were examined: cardiovascular death, major adverse cardiovascular events (MACE), myocardial infarction, stroke, mortality, heart failure, hypoglycemia, pancreatitis, and thyroid carcinoma. Secondary outcomes included: composite kidney outcome, worsening kidney function, macroalbuminuria, and retinopathy.Results: Seven trials involving 56,004 patients and eight interventions were identified. Albiglutide was associated with fewer MACE and myocardial infarction events compared with lixisenatide. Lixisenatide was related to a greater number of stroke events and cardiovascular deaths compared to once-weekly semaglutide and oral semaglutide, respectively. Improved mortality was associated with oral semaglutide compared with once-weekly semaglutide, albiglutide, dulaglutide, exenatide, or lixisenatide. Risks of heart failure, thyroid carcinoma, and pancreatitis were similar among all the treatments. Weighting of the nine primary outcomes identified oral semaglutide as first among the eight treatments examined. Among three of the secondary outcomes, once-weekly semaglutide ranked first. Better composite kidney outcome was observed with once-weekly semaglutide than with dulaglutide or exenatide; once-weekly semaglutide improved macroalbuminuria compared with exenatide or lixisenatide; and albiglutide, exenatide, and placebo was associated with fewer cases of retinopathy compared with once-weekly semaglutide. Meanwhile, kidney function was less likely to worsen with dulaglutide than with lixisenatide or placebo.Conclusion: Semaglutide should be considered when GLP-1 RAs are indicated for T2DM patients.

Oral semaglutide in the management of type 2 DM: Clinical status and comparative analysis

2021 ◽  
Vol 22 ◽  
Author(s):  
Ilora Bandyopadhyay ◽  
Sunny Dave ◽  
Amita Rai ◽  
Madhavan Nampoothiri ◽  
Mallikarjuna Rao Chamallamudi ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Comparative Analysis ◽  
Glycaemic Control ◽  
Receptor Agonist ◽  
Review Article ◽  
Second Line ◽  
Type 2 Dm ◽  
Glucagon Like Peptide ◽  
Glucagon Like Peptide 1

Background: In the incretin system, Glucagon-like peptide-1 (GLP-1) is a hormone that inhibits the release of glucagon and regulates glucose-dependent insulin secretion. In type 2 diabetes, correcting the impaired incretin system using GLP-1 agonist is a well-defined therapeutic strategy. Objectives: This review article aims to discuss the mechanism of action, key regulatory events, clinical trials for glycaemic control and comparative analysis of semaglutide with the second-line antidiabetic drugs. Description: Semaglutide is a glucagon-like peptide 1 (GLP 1) receptor agonist with enhanced glycaemic control in diabetes patients. In 2019, USFDA approved the first oral GLP-1 receptor agonist, semaglutide to be administered as a once-daily tablet. Further, recent studies highlight the ability of semaglutide to improve the glycaemic control in obese patients with a reduction in body weight. Still, in clinical practice, in type 2 DM treatment paradigm the impact of oral semaglutide remains unidentified. This review article discusses the mechanism of action, pharmacodynamics, key regulatory events, and clinical trials regarding glycaemic control. Conclusion: The review highlights the comparative analysis of semaglutide with the existing second-line drugs for the management of type 2 diabetes mellitus by stressing on its benefits and adverse events.

scholarly journals Anti-diabetic Agents and the Potentials for Reducing Cardiovascular Risks in Type-2 Diabetes Mellitus

2021 ◽  
Vol 7 (3) ◽  
pp. 208-226
Author(s):  
IU Ezeani ◽  
A Eregie ◽  
AE Ohwovoriole
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Cardiovascular Events ◽  
Mechanisms Of Action ◽  
Sglt2 Inhibitors ◽  
Major Adverse Cardiovascular Events ◽  
Cardiovascular Outcome Trials ◽  
Glucagon Like Peptide ◽  
Glucagon Like Peptide 1

Recent reports from Cardiovascular Outcome Trials (CVOTs) revealed that some newer anti-diabetic drugs impact Major Adverse Cardiovascular Events (MACE). These medications include the Sodium-Glucose Co-Transporter (SGLT2) inhibitors and the Glucagon-like Peptide-1 (GLP-1) receptor agonists. There is a need for a review of the mechanisms of action of these drugs, in addition to their glucose-lowering effects and CV benefits. This review paper aims to explore the cardio-protective effects and CV risks of anti-diabetic medications, their mechanisms of action and the CV benefits evidenced by CVOTs. Using internet search, with search items such as Type 2 Diabetes mellitus, cardiovascular risk factors, cardiovascular outcome trials, major adverse cardiovascular events, sodium-glucose transporter-2 inhibitors, glucagon-like peptide-1 receptor agonist, the Google Scholar, EMBASE, PubMed, Medline, Web MD, and Scopus were checked for various relevant published articles. Analyses of the results of multiple CVOTs from various parts of the world were considered. These CVOTs were reviewed to assess the role of anti-diabetic agents in reducing cardiovascular risk in patients with T2DM. The SGLT2 inhibitors and GLP1 agonists were found to be beneficial in lowering MACE when compared with placebo. This is in addition to their anti-hyperglycaemic benefits. In conclusion, SGLT2 inhibitors and GLP-1 agonists confer dramatic beneficial CV risk reduction on patients with T2DM, as shown by the various CVOTs. This is in addition to their anti-hyperglycaemic effects. This remarkable benefit justifies the need by various guidelines to adopt them as second line agents to metformin in managing patients with T2DM.

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