Non-insulin anti diabetic agents and cardiovascular outcomes

Type 2 diabetes, is a major risk factor for heart failure. Treatment with non-insulin anti diabetic agents in type 2 diabetic patients with cardiovascular diseases is complex. A1C does not always reflect the real state of glucose control at diabetic patients. The latest treatment algorithms are recommended to be adapted for all type 2 diabetic patients according to ADA and the EASD in order to delay or prevent acute and chronic complications of diabetes. Metformin continues to be safe concerning the reduction of cardiovascular outcomes like MI and coronary diseases in type 2 diabetes. Several classes of diabetes medications are questionable in heart failure safety like TZDs, possibly some DPP-4-i and SUs. In our original study with type 2 diabetic patients, besides beneficial effect on insulin resistance, glimepiride fails to show improvement in diastolic dysfunction but no worsening of this function was evident. SGLT2-i and GLP-1RA besides glucose control, appear to be safe with specific action mechanisms, in prevention of heart failure and reduction of cardiovascular death in type 2 diabetes.