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Advances in type 2 diabetes therapy: a focus on cardiovascular and renal outcomes
Author(s) -
Libianto Renata,
Davis Timothy ME,
Ekinci Elif I
Publication year - 2020
Publication title -
medical journal of australia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 131
eISSN - 1326-5377
pISSN - 0025-729X
DOI - 10.5694/mja2.50472
Subject(s) - medicine , saxagliptin , alogliptin , type 2 diabetes , metformin , intensive care medicine , diabetes mellitus , heart failure , adverse effect , kidney disease , dipeptidyl peptidase 4 , disease , pharmacology , endocrinology , sitagliptin
Summary Treatment options for type 2 diabetes have expanded. While metformin remains the first line treatment in most cases, choices for second line treatment now extend beyond sulfonylureas and include the sodium–glucose cotransporter 2 ( SGLT 2) inhibitors, glucagon‐like peptide 1 ( GLP 1) receptor agonists, and dipeptidyl peptidase 4 ( DPP 4) inhibitors. SGLT 2 inhibitors are recommended for people with atherosclerotic cardiovascular disease, heart failure or kidney disease. Diabetic ketoacidosis is an uncommon but important side effect; its occurrence can be minimised with appropriate patient education and management, especially during perioperative periods and times of illness. GLP 1 receptor agonists are recommended for people with atherosclerotic cardiovascular disease. Gastrointestinal side effects are common but are less prominent with the longer acting agents and can be minimised with slow titration of the shorter acting agents. DPP 4 inhibitors are generally well tolerated, but alogliptin and saxagliptin should be used with caution in people with risk factors for heart failure. To optimise the management of type 2 diabetes, clinicians need to be aware of the pharmacological characteristics of each class of blood glucose‐lowering medications and of the effect on cardiovascular health and renal function, balanced by potential adverse effects. Medications that have cardiovascular or renal benefits should be prescribed for patients with these comorbidities, and this is reflected in recent international guidelines.