Emerging glucose-lowering therapies: a guide for cardiologists

In recent large-scale cardiovascular outcomes trials, two new classes of glucose-lowering medications – sodium glucose co-transporter 2 inhibitors (SGLT2i) and glucagon like peptide-1 receptor agonists (GLP-1RAs) – demonstrated cardiovascular benefits in adults with type 2 diabetes mellitus (T2DM). These findings have prompted growing optimism amongst clinicians regarding the potential for these agents to reduce the burden of cardiovascular disease in people with T2DM. GLP-1RAs and SGLT2i are now advocated as second-line agents in European and U.S. guidelines for management of both hyperglycaemia and for primary prevention of cardiovascular disease in people with T2DM. Given the high prevalence of T2DM in patients with cardiovascular disease, cardiologists will increasingly encounter these agents in routine clinical practice. In this review, we summarise evidence from cardiovascular outcomes trials of GLP-1RAs and SGLT2i, give practical advice on prescribing, and detail safety considerations associated with their use. We also highlight areas where further work is needed, giving details on active clinical trials. The review aims to familiarise cardiologists with these emerging treatments, which will be increasingly encountered in clinical practice, given the expanding representation of T2DM in patients with cardiovascular disease. Whether these drugs will be initiated by cardiologists remains to be determined.