Hinnen Debbie, Kruger Davida, Magwire Melissa
University of Colorado Health, Colorado Springs, Colorado, USA.
Henry Ford Health System, Division of Endocrinology, Diabetes, Bone, and Mineral Disease, Detroit, Michigan, USA.
Postgrad Med. 2023 Jan;135(1):2-12. doi: 10.1080/00325481.2022.2126235. Epub 2022 Oct 18.
People with type 2 diabetes (T2D) have a higher risk of cardiovascular (CV) disease (CVD) than those without. This increased risk begins with pre-diabetes, potentially 7-10 years before T2D is diagnosed. Selecting medication for patients with T2D should focus on reducing the risk of CVD and established CVD. Within the last decade, several antihyperglycemic agents with proven CV benefit have been approved for the treatment of hyperglycemia and for the prevention of primary and secondary CV events, including glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter-2 inhibitors. T2D treatment guidelines recommend that an antihyperglycemic agent with proven CV benefit should be used after metformin in patients with high risk of or established CVD, regardless of glycated hemoglobin levels. Despite the availability of antihyperglycemic agents with proven CV benefit, and guidelines on when to use them, less than one in four patients with T2D and CVD receive this type of therapy. These findings suggest a potential gap between current recommendations and clinical practice. This article reviews the approved agents with CV indications, with a focus on injectable GLP-1RAs, and their place in the T2D treatment paradigm according to current guidelines. We aim to provide primary healthcare providers with in-depth information on subsets of patients who would benefit from this type of therapy and when it should be initiated, taking into consideration safety and tolerability and other disease factors. An individualized treatment approach is increasingly recommended in the management of T2D, employing a shared decision-making strategy between patients and healthcare professionals.
2型糖尿病（T2D）患者患心血管（CV）疾病（CVD）的风险高于非糖尿病患者。这种风险增加始于糖尿病前期，可能在T2D确诊前7 - 10年就已出现。为T2D患者选择药物应侧重于降低CVD风险和已确诊的CVD。在过去十年中，几种已证实具有心血管益处的抗高血糖药物已被批准用于治疗高血糖以及预防原发性和继发性心血管事件，包括胰高血糖素样肽-1受体激动剂（GLP-1RAs）和钠-葡萄糖协同转运蛋白-2抑制剂。T2D治疗指南建议，对于有高CVD风险或已确诊CVD的患者，在使用二甲双胍后应使用已证实具有心血管益处的抗高血糖药物，无论糖化血红蛋白水平如何。尽管有已证实具有心血管益处的抗高血糖药物以及关于何时使用它们的指南，但在患有T2D和CVD的患者中，不到四分之一的患者接受这种类型的治疗。这些发现表明当前建议与临床实践之间可能存在差距。本文回顾了具有心血管适应症的已批准药物，重点是注射用GLP-1RAs，以及根据当前指南它们在T2D治疗模式中的地位。我们旨在为初级医疗保健提供者提供深入信息，说明哪些患者亚组将从这种类型的治疗中获益以及何时应开始治疗，同时考虑安全性、耐受性和其他疾病因素。在T2D管理中，越来越推荐采用个体化治疗方法，采用患者与医疗保健专业人员之间的共同决策策略。
