Associate Professor of Medicine, Harvard Medical School

Co-director, Division of Continuing Medical Education, BIDMC

Managing Diabetes and Reducing Cardiovascular Risk

The newer classes of medications currently available to treat people with type 2 diabetes (T2DM) – in particular GLP 1 receptor agonists and SGLT2 inhibitors – have additional advantages beyond their glucose lowering effects. Their use is associated with weight loss (GLP 1 RA > SGLT2 inhibitors) and they do not cause hypoglycemia when used alone, with metformin or with each other. Both classes of medications reduce major adverse cardiovascular events (MACE) in people with established cardiovascular disease. One GLP 1 RA (Dulaglutide) is also approved for primary prevention of cardiovascular disease (CVD). SGLT2 inhibitors also reduce hospitalization and cv mortality in people with heart failure (HF), with or without reduced ejection fraction, in people with or without type 2 diabetes, and also slow the progression of chronic kidney disease. Some GLP1 RA also have renoprotective effects.

Given these additional advantages, these classes of medications should be used regardless of A1c in people with, or at high risk for ASCVD, individuals with HF and those with CKD.