Choosing Medications for Type 2 Diabetes - What Weighting Should Be Given to Cardiovascular Risk Reduction?

Cardiovascular risk reduction is an integral part of diabetes management. Patients with type 2 diabetes mellitus are at an increased risk of adverse cardiovascular events compared to those without diabetes, and despite efforts at risk reduction including smoking cessation and blood pressure and cholesterol optimization, the majority of people with type 2 diabetes mellitus continue to die from cardiovascular disease. Acarbose was compared to sulfonylureas as adjunctive therapy for people with type 2 diabetes. A quick-release formulation of bromocriptine is approved for the treatment of type 2 diabetes. Sodium glucose cotransporter 2 inhibitors (SGLT-2i) are a new class of anti-hyperglycemic agents that function to concomitantly inhibit the reabsorption of glucose and sodium in the renal proximal convoluting tubule. It is notable that the actions of SGLT-2i are independent of the integrity of the insulin secretory apparatus, and can theoretically lower glucose in people with type 1 diabetes.