Feature Article

Established CVD in people with type 2 diabetes: what pharmacotherapy should be considered?

Kenrick Blaker, Roger Chen

Figures

© GARO/PHANIE/SPL
© GARO/PHANIE/SPL

Abstract

The results of recent cardiovascular outcome studies have significantly influenced pharmacotherapeutic recommendations for patients with type 2 diabetes who have established cardiovascular disease or risk factors. The new advice is that sodium-glucose cotransporter-2 inhibitors or glucagon-like peptide-1 receptor agonists should be considered on top of standard care. However, the importance of achieving glycaemic targets remains, and the patient’s GP and other members of the patient’s diabetes team also need to address other complications of diabetes.

Key Points

  • The management of type 2 diabetes requires that cardiovascular risk factors are addressed. Lifestyle advice, smoking cessation counselling and appropriate pharmacotherapy to attain glycaemic, lipid and blood pressure targets are all essential.
  • The results of recent cardiovascular outcome studies have significantly influenced pharmacotherapeutic recommendations.
  • Consensus recommendations from the American Diabetes Association and European Society for the Study of Diabetes indicate that in high-risk individuals, a glucagon-like peptide-1 receptor agonist (GLP-1 RA) or sodium-glucose cotransporter-2 (SGLT-2) inhibitor should be considered, GLP-1 RAs should also be considered in patients with type 2 diabetes without established cardiovascular disease (CVD) but with the presence of specific indicators of high risk, and SGLT-2 inhibitors are recommended in patients with type 2 diabetes and heart failure as well as in patients with type 2 diabetes with chronic kidney disease.
  • The Australian Diabetes Society type 2 diabetes treatment algorithm also indicates that the choice of agents should be guided by clinical considerations (e.g. the presence of CVD).
  • The use of these newer agents and their potential benefits does not negate the importance of setting and achieving appropriate glycaemic targets.
  • When these agents are used, a detailed discussion about the potential benefits and also the potential side effects is required.

Figures

© GARO/PHANIE/SPL
© GARO/PHANIE/SPL