Novelties from diabetology with cardiological concerns
Bajcsy-Zsilinszky Kórház és Rendelőintézet, Budapest
The care of diabetic patients often needs tight collaboration between diabetologists and other medical specialists. Due to the cardiovascular complications of patients with type 2 diabetes the consultations between cardiologists and diabetologists are of great importance during the treatment. The recently completed cardiovascular safety trials with novel, innovative antihyperglycaemic drugs provided important information for both cardiologists and diabetologists.
Cardiovascular safety of DPP-4-inhibitors was demonstrated by several large clinical trials; the safety of saxagliptin was documented in SAVOR trial while alogliptin in
EXAMINE and sitagliptin in TECOS trials. Nevertheless, the increased risk of hospitalization for heart failure in SAVOR with saxagliptin was not expected. Among GLP-1-receptor agonists, the results of ELIXA trial with lixisenatide and those of EXSCEL trial with exenatide once weekly were neutral, which prove the cardiovascular safety of these drugs. On the other hand, SUSTAIN-6 trial with semaglutide once weekly and LEADER trial with liraglutide demonstrated cardiovascular benefit beyond safety. Among SGLT-2-inhibitors, EMPA-REG OUTCOME trial with empagliflozine and the CANVAS Program with canagliflozine also proved to be beneficial in several clinical outcome measures. Finally, DEVOTE trial documented the cardiovascular safety of degludec insulin.
Based on the results of cardiovascular safety trials, the preference of antihyperglycaemic drugs with cardiovascular benefits (in Hungary at 2017: empagliflozine, liraglutide) for treating type 2 diabetic patients was emphasized in several updated clinical guidelines. The novelties of these studies also highlighted the importance of collaboration between diabetologists and cardiologists.