Glycemic Control and Cardiovascular Benefits of New Diabetes Medications
Diabetes is a chronic condition affecting millions worldwide (including my own family), and its management has come a long way since the discovery of insulin in 1921. Today, the focus of diabetes treatment extends beyond glycemic control to addressing the significant cardiovascular and renal complications that accompany type 2 diabetes. Two revolutionary classes of medications—glucagon-like peptide-1 (GLP-1) receptor agonists and sodium-glucose cotransporter-2 (SGLT-2) inhibitors—are leading the way in this evolution.
Understanding GLP-1 Receptor Agonists and SGLT-2 Inhibitors
GLP-1 receptor agonists mimic the hormone GLP-1, which stimulates insulin secretion, reduces appetite, and slows gastric emptying. These effects help manage blood sugar levels while also promoting weight loss. SGLT-2 inhibitors work by preventing glucose reabsorption in the kidneys, leading to increased glucose excretion through urine. Both classes have shown remarkable cardiovascular and renal benefits beyond their impact on blood sugar control.
The Evidence Behind the Benefits
Recent cardiovascular outcome trials provide strong evidence of the additional benefits of these medications:
GLP-1 Receptor Agonists: Trials like LEADER, SUSTAIN-6, and REWIND revealed significant reductions in major adverse cardiovascular events (MACE), including heart attack, stroke, and cardiovascular mortality.
SGLT-2 Inhibitors: Studies such as EMPA-REG OUTCOME and CREDENCE demonstrated reduced heart failure hospitalizations and lower risks of cardiovascular and renal complications.
These medications not only improve glycemic control but also provide life-saving benefits for patients with type 2 diabetes, regardless of their glycemic status.
Challenges in Utilization
Despite their proven benefits, GLP-1 receptor agonists and SGLT-2 inhibitors are underutilized, with only 1%–5% of eligible patients receiving these therapies. Barriers include:
Cost: Annual out-of-pocket expenses for these drugs range from $1,000 to $1,500 for Medicare Part D enrollees.
Administrative Burden: Pre-authorization requirements can deter healthcare providers from prescribing these medications.
Implications for Diabetes Care
The evidence supports broader use of GLP-1 receptor agonists and SGLT-2 inhibitors in patients with type 2 diabetes, particularly those with a history of cardiovascular or renal disease. Their dual benefits extend to weight management and reduced cardiovascular risks, positioning them as essential tools in modern diabetes care.
The Path Forward
Overcoming barriers to the use of these medications requires collaboration among healthcare providers, policymakers, and insurers. Streamlining the prescribing process and addressing affordability will be critical to ensuring more patients benefit from these life-saving therapies.
In conclusion, the introduction of GLP-1 receptor agonists and SGLT-2 inhibitors marks a significant milestone in diabetes treatment. By incorporating these medications into routine practice, clinicians can achieve improved outcomes in glycemic, cardiovascular, and renal health—changing the trajectory of type 2 diabetes management for millions of patients worldwide.
Citation: Draznin B, Hirsch IB. Time to Follow the Evidence: Glycemic Control and Cardiovascular Benefits of New Diabetes Medications. The American Journal of Medicine. 2021;134(4):420-422. doi:https://doi.org/10.1016/j.amjmed.2020.12.012