Focus on New Diabetes Treatment Options with Cardiovascular Benefits

Abstract

The landscape of diabetes treatment options has changed due to new diabetes drug approvals, changes in the Food and Drug Administration indications based on cardiovascular (CV) outcomes studies, as well as the approval of follow-on biologic insulins. Two new drugs were approved for type 2 diabetes mellitus including ertugliflozin, a sodium-glucose cotransporter 2 (SGLT2) inhibitor, and semaglutide, a glucagon-like peptide-1 (GLP1) receptor agonist joining a number of other drugs in these classes. In addition, follow-on biologic insulins, such as long-acting Basaglar (insulin glargine), and rapid-acting insulins Admelog (insulin lispro) and Fiasp (insulin aspart), were also approved. Furthermore, the CV outcome trial for dapagliflozin was published in November 2018 showing CV benefits. Finally, the 2018 joint American Diabetes Association (ADA) and European Association for the Study of Diabetes statement on the management of type 2 diabetes and the 2019 ADA Standards of Care for Diabetes made several recommendations. They encourage the use of agents with CV benefit in those with established atherosclerotic cardiovascular disease (ASCVD) or heart failure and to consider GLP1 receptor agonists as the first injectable agent, even before basal insulin, in certain patients. The purpose of this review is to discuss recently approved agents for type 2 diabetes comparing the available cardiovascular findings of SGLT2 inhibitors and GLP1 receptor agonists and outline key take-home points when recommending additional treatment for patients with type 2 diabetes after metformin.