New type 2 diabetes drugs and their cardiovascular effects

Emily Meyer, Stephen Stranks



Recent cardiovascular outcome trials have shown that drugs in the new glucose-lowering medication classes, the GLP-1 receptor agonists, the DPP-4 inhibitors and the SGLT-2 inhibitors, are safe to use in patients with type 2 diabetes and can, to varying degrees, improve various cardiovascular risk factors. Correction A correction for this article has been published in the July 2016 issue of Endocrinology Today. The full text PDF for this article (see link above) has been corrected.

Key Points

  • Cardiovascular disease is the leading cause of death, morbidity and hospitalisation in people with type 2 diabetes.
  • Several new classes of antidiabetic agents can improve various cardiovascular risk factors, including weight, blood pressure and lipid profile, in addition to lowering blood glucose levels. They rarely cause hypoglycaemia.
  • Cardiovascular outcome studies to date support the safety of three dipeptidyl peptidase-4 (DPP-4) inhibitors (alogliptin, saxagliptin and sitagliptin), one glucagon-like peptide-1 (GLP-1) receptor agonist (lixisenatide) and one sodium–glucose cotransporter-2 (SGLT-2) inhibitor (empagliflozin) in people with type 2 diabetes who have, or are at high risk of, cardiovascular disease.
  • Specific cardiovascular benefits of DPP-4 inhibitors and GLP-1 receptor agonists over standard diabetes therapy have not yet been demonstrated.
  • There remains some concern about DPP-4 inhibitors and heart failure risk despite the reassuring findings with sitagliptin in the TECOS trial.
  • One study has shown that the use of the SGLT-2 inhibitor empagliflozin in patients with type 2 diabetes and established cardiovascular disease improves cardiovascular and all-cause mortality and heart failure outcomes.

    Picture credit: © Reineg/Dollar Photo Club.