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J Gen Intern Med. 2017 Sep;32(9):1044-1051. doi: 10.1007/s11606-017-4061-7. Epub 2017 May 26.

Shifting Paradigms in the Medical Management of Type 2 Diabetes: Reflections on Recent Cardiovascular Outcome Trials.

Author information

1
Division of Clinical and Molecular Endocrinology, Department of Medicine, Case Western Reserve University and VA Medical Center, 10900 Euclid Ave., Cleveland, OH, 44106-4951, USA. fxi2@case.edu.
2
Department of Medicine, UCLA, Geffen School of Medicine, Los Angeles, CA, USA.
3
Department of Cardiology, Saint Luke's Mid America Heart Institute, University of Missouri, Kansas City, MO, USA.
4
Section of Endocrinology, Yale School of Medicine and Yale-New Haven Hospital, New Haven, CT, USA.

Abstract

An important challenge in the management of patients with type 2 diabetes is cardiovascular disease (CVD) prevention. While it is well established that intensive glycemic control prevents the onset and slows the progression of certain microvascular complications, such a strategy utilized in multiple clinical trials over the past few decades has failed to show a similar benefit with regard to cardiovascular events, including mortality. Despite this, a major hope has been the discovery of glucose-lowering medications that simultaneously improve cardiovascular outcomes. Over the past year and a half, four randomized clinical trials (involving empagliflozin, pioglitazone, liraglutide, and semaglutide) have reported important benefits in preventing adverse cardiovascular outcomes in patients with or at risk for type 2 diabetes and established CVD. On the basis of these landmark trials, we propose that a paradigm shift in the management of patients with type 2 diabetes, specifically in those with prior macrovascular disease. A transition from current algorithms based primarily on hemoglobin A1c values to a more comprehensive strategy additionally focused on CVD prevention seems warranted.

KEYWORDS:

MACE; The views expressed in this article do not represent any organization or entity; glycemic control; heart failure; hypoglycemia; individualization

PMID:
28550608
PMCID:
PMC5570736
DOI:
10.1007/s11606-017-4061-7
[Indexed for MEDLINE]
Free PMC Article

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