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Cardiovascular outcome trials of glucose-lowering medications: an update – published online 03/01/2019

Cardiovascular outcome trials of glucose-lowering medications: an update – published online 03/01/2019

Philip Home

Cardiovascular outcome trials (CVOTs) of glucose-lowering medications that have been completed in recent years have provided welcome pointers towards best use of these drugs in diabetes care. However, many questions and uncertainties remained. In this issue, Philip Home (https://doi.org/10.1007/s00125-018-4801-1) discusses studies in three major glucose-lowering drug classes, which were published and presented recently (October/November 2018). These studies help to confirm or clarify our understanding of how the three classes should be positioned clinically and whether there are within-class differences. For dipeptidyl peptidase-4 (DPP4) inhibitors, CARMELINA confirmed neutrality for cardiovascular outcomes, with no heart failure signal, albeit in a highly selected population. For GLP-1 receptor agonists, the Harmony Outcome study confirmed an early and continuing benefit for cardiovascular protection for this class, independent of glucose- or body-weight-lowering. For sodium–glucose cotransporter-2 (SGLT2) inhibitors, DECLARE-TIMI 58 confirmed strong renal protection and protection against heart failure, even in people without prior cardiovascular disease, but did not further clarify class issues around major cardiovascular outcomes. Studies in these three classes are now transforming guidelines for the use of glucose-lowering medications, notably extending them beyond glucose-lowering to managing the adverse vascular and renal manifestations of diabetes.  The three studies discussed here drive guideline changes more firmly for the benefit of people with type 2 diabetes, and related studies due in the next 12 months will take that process further.

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