Prescribe SGLT2 inhibitors or GLP1 receptor agonists to reduce CV risk in diabetes: Expert Consensus

The American College of Cardiology has released the 2020 expert consensus decision pathway (ECDP) on novel therapies for cardiovascular risk reduction in type 2 diabetes (T2D) patients.

The guidance, published in the Journal of the American College of Cardiology suggests that clinicians should consider prescribing sodium-glucose cotransporter 2 (SGLT2) inhibitors or glucagon-like peptide 1 (GLP-1) receptor agonists for patients with diabetes and high cardiovascular risk in order to reduce CV risk. 

This ECDP reflects the change in the paradigm of how the CV specialist should approach the care of patients with T2D. Earlier, CV specialists focused on the optimization of risk factor in diabetes patients. Medications used for blood sugar control were not adjusted by CV specialists, in part because they were not expected to demonstrate direct CV benefit.

The recent developments of SGLT2 inhibitors and GLP-1RAs has, for the first time, demonstrated that specific treatments developed for glucose lowering can directly improve CV outcomes. In large, well-conducted, randomized clinical trials, specific medications in these 2 classes have been proven to reduce rates of acute MI, stroke, and CV death in patients with T2D (most with established ASCVD). These benefits appear to be independent of their effects on HbA1c. Thus, CV specialists now need to incorporate these agents into their care of patients with T2D, and coordinate care with the primary diabetes care providers, to optimize clinical outcomes in patients with diabetes.