01

recently, a study published in the journal of the american college of cardiology (jacc) showed that for patients withtype 2 diabetesfor patients with cardiovascular disease, the use of sodium-glucose co-transporter-2 inhibitors (sglt2i) and glucagon-like peptide-1 receptor agonists (glp-1ra) can not only effectively control blood sugar, but also significantly reduce the risk of major adverse cardiovascular events (mace).

the results of the study showed that these two classes of drugs were superior to dipeptidyl peptidase-4 inhibitors (dpp-4i), which in turn were superior to sulfonylureas. these recommendations prioritize the use of sglt2i and glp-1ra as second-line treatment in patients with established cardiovascular disease.

02

there is evidence that sglt2i and glp-1ra can not only control blood sugar, but also reduce the risk of major adverse cardiovascular events in patients with type 2 diabetes. however, there is currently a lack of head-to-head clinical trials that directly compare the effectiveness of sglt2i, glp-1ra and other second-line glucose-lowering drugs.

the study, called "legend-t2dm", used real-world data from ten databases in the united states, germany, spain and the united kingdom. most of these data cover electronic health records from mid-2000 to 2021, with a treatment period of more than 20 years. the purpose of the study is to evaluate the effectiveness of four second-line glucose-lowering drugs (sglt2i, glp-1ra, dpp-4i and sulfonylureas) in patients with type 2 diabetes treated with metformin as the basis for cardiovascular disease.

the researchers screened approximately 1.493 million patients with type 2 diabetes and cardiovascular disease who had been treated with metformin monotherapy for at least three months and subsequently started one of four second-line glucose-lowering drugs. the specific distribution is as follows:

• 245,000 patients (16.4%) started sglt2i;

• 124,000 (8.3%) patients used glp-1ra;

• 13,000 patients (27.7%) started using dpp-4i;

• 711,000 patients (47.6%) started using sulfonylureas.

the primary outcome of the study was a 3-point mace (includingacute myocardial infarction, stroke, and sudden cardiac death) and a “4-point mace” event (i.e., a “3-point mace plusheart failureduring the 1.338 million person-years of follow-up, there were 25,982 3-point mace events and 41,447 4-point mace events. the analysis results showed:

1. compared with dpp-4i, the use of sglt2i and glp-1ra reduced the risk of 3-point mace by 11% and 17%, respectively;

2. compared with sulfonylureas, the use of sglt2i and glp-1ra reduced the risk of 3-point mace by 24% and 28%, respectively;

3. compared with sulfonylureas, the use of dpp-4i reduced the risk of 3-point mace by 13%;

4. similar results were observed in the analysis of 4-point mace risk;

5. there was no significant difference in the risk of either 3-point mace or 4-point mace between sglt2i and glp-1ra.

03

this study explored the relationship between type 2 diabetes andatherosclerosisthe real-world effects of drug use in patients with cardiovascular disease provide new insights into the clinical use of these drugs. the research team emphasized that these research results have important guiding value for clinical practice and are consistent with the recommendation in clinical practice guidelines to give priority to the use of sglt2 inhibitors and glp-1 receptor agonists in patients with confirmed cardiovascular disease.

at the same time, the review article related to the study also pointed out that this study is of great significance for evaluating the effectiveness of drugs in actual clinical settings and drug usage patterns, which will help other researchers better understand the use of these drugs in the treatment of type 2 diabetes and atherosclerotic cardiovascular disease. the research team believes that these findings have a significant impact on clinical practice and further support the clinical practice guidelines that prioritize the use of sglt2 inhibitors and glp-1 receptor agonists in patients who have been diagnosed with cardiovascular disease.

refer to

Khera, Rohan, et al. "Comparative effectiveness of second-line antihyperglycemic agents for cardiovascular outcomes: a multinational, federated analysis of LEGEND-T2DM." Journal of the American College of Cardiology 84.10 (2024): 904-917.