GLP1-RA and SGLT2-i: Implementation and Insulin Deescalation Strategies.

IF 3.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Cardiovascular Drugs and Therapy Pub Date : 2025-07-10 DOI:10.1007/s10557-025-07744-8

Arthi Palani, Sagar Patel, Shriya Patel, Shivani Srivastava, Jay Patel, Salman Salehin, Yochai Birnbaum, Joseph Allencherril

{"title":"GLP1-RA and SGLT2-i: Implementation and Insulin Deescalation Strategies.","authors":"Arthi Palani, Sagar Patel, Shriya Patel, Shivani Srivastava, Jay Patel, Salman Salehin, Yochai Birnbaum, Joseph Allencherril","doi":"10.1007/s10557-025-07744-8","DOIUrl":null,"url":null,"abstract":"Purpose of review: This review will summarize the most contemporary trials for glucagon-like peptide 1 receptor agonists (GLP1-RA) and sodium-glucose cotransporter 2 inhibitors (SGLT2-i) and present guidance on management and recommendations on adjunctive tapering of insulin in patients with insulin-dependent diabetes mellitus, which we term \"de-insulinization.\"Recent findings: GLP1-RA and SGLT2-i are the principal classes of diabetes medications evidencing cardiovascular benefit. However, there is limited consensus on how to effectively prescribe and maintain these medications for patients on other glucose-lowering therapy, especially insulin. Patients with type 2 diabetes and cardiovascular disease should be started on either a GLP-1RA, SGLT-i, or both in high-risk cases, while simultaneously tapering any prescribed insulin regimen. Initial selection and transition of therapy should be approached individually and systematically, with prioritization of patients with other comorbidities such as coronary artery disease, chronic kidney disease, and other diabetes complications.","PeriodicalId":9557,"journal":{"name":"Cardiovascular Drugs and Therapy","volume":" ","pages":""},"PeriodicalIF":3.1000,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Cardiovascular Drugs and Therapy","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s10557-025-07744-8","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}

引用次数: 0

Abstract

Purpose of review: This review will summarize the most contemporary trials for glucagon-like peptide 1 receptor agonists (GLP1-RA) and sodium-glucose cotransporter 2 inhibitors (SGLT2-i) and present guidance on management and recommendations on adjunctive tapering of insulin in patients with insulin-dependent diabetes mellitus, which we term "de-insulinization."

Recent findings: GLP1-RA and SGLT2-i are the principal classes of diabetes medications evidencing cardiovascular benefit. However, there is limited consensus on how to effectively prescribe and maintain these medications for patients on other glucose-lowering therapy, especially insulin. Patients with type 2 diabetes and cardiovascular disease should be started on either a GLP-1RA, SGLT-i, or both in high-risk cases, while simultaneously tapering any prescribed insulin regimen. Initial selection and transition of therapy should be approached individually and systematically, with prioritization of patients with other comorbidities such as coronary artery disease, chronic kidney disease, and other diabetes complications.

查看原文本刊更多论文

GLP1-RA和SGLT2-i：实施和胰岛素降级策略。

综述目的：本综述将总结最新的胰高血糖素样肽1受体激动剂（GLP1-RA）和钠-葡萄糖共转运蛋白2抑制剂（SGLT2-i）的临床试验，并对胰岛素依赖型糖尿病患者辅助胰岛素减量的管理和建议提供指导，我们称之为“去胰岛素化”。“最近的发现：GLP1-RA和SGLT2-i是糖尿病药物的主要类别，证明心血管有益。然而，对于如何有效地为接受其他降糖治疗的患者开处方和维持这些药物，尤其是胰岛素，目前还没有达成一致意见。患有2型糖尿病和心血管疾病的患者应开始使用GLP-1RA或SGLT-i，或在高危病例中同时使用两者，同时逐渐减少任何处方胰岛素方案。治疗的初始选择和过渡应单独和系统地进行，优先考虑有其他合并症的患者，如冠状动脉疾病、慢性肾脏疾病和其他糖尿病并发症。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Cardiovascular Drugs and Therapy 医学-心血管系统

CiteScore

8.30

自引率

0.00%

发文量

110

审稿时长

4.5 months

期刊介绍： Designed to objectively cover the process of bench to bedside development of cardiovascular drug, device and cell therapy, and to bring you the information you need most in a timely and useful format, Cardiovascular Drugs and Therapy takes a fresh and energetic look at advances in this dynamic field. Homing in on the most exciting work being done on new therapeutic agents, Cardiovascular Drugs and Therapy focusses on developments in atherosclerosis, hyperlipidemia, diabetes, ischemic syndromes and arrhythmias. The Journal is an authoritative source of current and relevant information that is indispensable for basic and clinical investigators aiming for novel, breakthrough research as well as for cardiologists seeking to best serve their patients. Providing you with a single, concise reference tool acknowledged to be among the finest in the world, Cardiovascular Drugs and Therapy is listed in Web of Science and PubMed/Medline among other abstracting and indexing services. The regular articles and frequent special topical issues equip you with an up-to-date source defined by the need for accurate information on an ever-evolving field. Cardiovascular Drugs and Therapy is a careful and accurate guide through the maze of new products and therapies which furnishes you with the details on cardiovascular pharmacology that you will refer to time and time again.