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Changing the approach to type 2 diabetes treatment: A comparison of glucagon-like peptide-1 receptor agonists and sulphonylureas across the continuum of care
- Source :
- Diabetes/Metabolism Research and Reviews
- Publication Year :
- 2020
-
Abstract
- Despite the importance of individualised strategies for patients with type 2 diabetes mellitus (T2DM) and the availability of alternative treatments, including glucagon‐like peptide‐1 receptor agonists (GLP‐1 RAs), sulphonylureas are still widely used in practice. Clinical evidence shows that GLP‐1 RAs may provide better and more durable glycaemic control than sulphonylureas, with lower risk of hypoglycaemia. Other reported benefits of GLP‐1 RAs include weight loss rather than weight gain (as observed with sulphonylureas), blood pressure reduction and improvement in lipid profiles. In general, the main adverse events with GLP‐1 RAs are gastrointestinal in nature. The respective modes of action of GLP‐1 RAs and sulphonylureas contribute to differences in the durability of glycaemic control (related to effects on beta‐cells) and effects on body weight. Moreover, the glucose‐dependent mode of action of GLP‐1 RAs, which favours a low incidence of hypoglycaemia, contrasts with the glucose‐independent mode of action of sulphonylureas. Evidence from cardiovascular outcomes trials indicates a consistent finding of cardiovascular safety across the GLP‐1 RAs and suggests a class benefit for the long‐acting GLP‐1 RAs in reducing three‐point major adverse cardiovascular events, cardiovascular mortality and all‐cause mortality. In contrast, potential concerns relating to an increased incidence of adverse cardiovascular events with sulphonylureas have yet to be fully resolved. Recent updates to management guidelines recommend that treatment selection for patients with T2DM should consider clinical trial evidence of cardiovascular safety. Available evidence suggests that this selection should give preference to GLP‐1 RAs over sulphonylureas, especially for patients at high cardiovascular risk.
- Subjects :
- endocrine system
Endocrinology, Diabetes and Metabolism
030209 endocrinology & metabolism
Type 2 diabetes
Review Article
030204 cardiovascular system & hematology
Bioinformatics
Lower risk
Glucagon-Like Peptide-1 Receptor
03 medical and health sciences
0302 clinical medicine
Endocrinology
cardiovascular safety
Weight loss
Diabetes mellitus
Internal Medicine
medicine
Humans
Hypoglycemic Agents
GLP‐1 RAs
Adverse effect
Review Articles
business.industry
Type 2 Diabetes Mellitus
Continuity of Patient Care
medicine.disease
Hypoglycemia
Clinical trial
Blood pressure
glycaemic control
Diabetes Mellitus, Type 2
sulphonylureas
durability
medicine.symptom
business
hypoglycaemia
Subjects
Details
- ISSN :
- 15207560
- Volume :
- 37
- Issue :
- 7
- Database :
- OpenAIRE
- Journal :
- Diabetes/metabolism research and reviews
- Accession number :
- edsair.doi.dedup.....8a1a91058c3442b0219a747646cbca91