Treatment of diabetes and cardiovascular risk: the end of a dogma in the treatment of type 2 diabetes
Abstract
Modern treatment of diabetes is based on several principles, which aim to prevent vascular complications impairing quality of life of diabetic patients and increasing the cost of their treatment. One of the principles is an early identification of high-risk patients, early initiation of individualized antihypeglycaemic therapy and long-term optimal diabetes control.
Another principle of diabetes treatment is the emphasis on its safety. For this reason, all modern antidiabetic drugs are required to be tested in dedicated cardiovascular focused trials conducted in high risk diabetes populations.
So far, we have the data supporting the cardiovascular safety of most of the antidiabetic agents based on the incretin action (dipeptidyl peptidase 4 inhibitors and GLP-1 receptor agonists). In the first study with a representative of the inhibitors of SGLT2 transporters (their mode of action is an induction of therapeutic glycosuria) empagliflozin, statistically and clinically significant reduction of cardiovascular risk (cardiovascular mortality, total mortality and the incidence of heart failure) was observed, quite unexpectably.
A new emerging principle can now be applied in diabetology. Aside from the traditional long-term prevention of microvascular complications, the treatment with empagliflozin in patients at high cardiovasular risk can in a short-term positively affect their morbidity and mortality.