There are many drugs for type 2 diabetes, but one class may be specific to protecting the heart, new research suggests.
A study of thousands of diabetic US veterans found that those who added GLP-1 receptor agonists to their routine regimens were less likely to have a first heart attack or stroke in the coming years.
This was compared to vets who added one of two other diabetes medications.
GLP-1 receptor agonists are a new class of drugs for type 2 diabetes and include drugs such as dulaglutide (TrucT), liraglutide (Victoza), and semaglutide (Ozympic). They are usually taken by injection.
The drugs are an option for people who already have type 2 diabetes, or those who have or are at risk for heart disease — with additional conditions such as high blood pressure or obesity.
Experts say the new findings – published May 9 in the Annals of Internal Medicine – do not mean that all diabetic patients with heart problems should be on GLP-1 medication.
For one, the study was not the first clinical trial to examine which type of diabetes drug was best at preventing heart disease.
But the findings show that GLP-1 drugs are associated with a better cardiovascular outlook than other drugs, said senior researcher Dr. Christian Rome.
“I think these findings are important for the care of diabetic patients,” said Romy, a professor of medicine at Vanderbilt University Medical Center in Nashville, Tenn.
She said the results could encourage more doctors to consider GLP-1 drugs as a “complementary” treatment to prevent heart disease.
More than 37 million Americans have diabetes, and most have type 2, according to government figures.
Type 2 diabetes occurs when the body is unable to properly use the hormone insulin, which controls blood sugar levels. Over time, chronic high blood sugar damages blood vessels and contributes to problems such as heart and kidney disease.
For years, the first-line treatment for type 2 diabetes has been metformin — an inexpensive oral hypoglycemic drug.
But in recent years, new options have emerged. In addition to GLP-1 medications, there are oral medications called SGLT2 inhibitors, such as canagliflozin (Invokana), dapagliflozin (Farxiga), and empagliflozin (Jardiance).
Recent guidelines from the American Diabetes Association and other groups now recommend both of those drug classes as options for people at risk for heart disease.
That’s based on trials showing the drugs reduce the risk of complications such as heart attacks, strokes and heart attacks.
What’s not clear, Rumi said, is how the drugs stack up against each other.
Her team looked at medical records from thousands of US soldiers who were treated for diabetes between 2001 and 2019.
All were initially treated with standard, older drugs, such as metformin or insulin, and then another drug was added: either a GLP-1 or SGLT2 drug, or another relatively new type of diabetes drug, a DPP-4 inhibitor (such as sitagliptin (Januvia)) and saxagliptin. (English).
Over eight years, patients on GLP-1 drugs were 18 percent less likely to have a first heart attack or stroke than those on DPP-4 drugs. Those on SGLT2 drugs, however, did not show any benefit.
Dr. Brian Blaise is an endocrinologist at NYU Langone in Brooklyn who sees patients with diabetes regularly. He said he was surprised that GLP-1 drugs were associated with heart benefits, given previous research.
In his own experience, Blaise said the drugs do a particularly good job of lowering patients’ A1C levels — a measure of long-term blood sugar control.
Although it was surprising that SGLT2 drugs were not associated with a better cardiovascular outlook than DPP-4 drugs.
According to researcher Rumi, DPP-4 drugs are considered “neutral” in terms of heart health. In contrast, GLP-1 and SGLT2 drugs are thought to have cardioprotective effects beyond blood sugar control—for example, by reducing inflammation or improving blood vessel function.
Blaise said there is a tendency to favor GLP-1 drugs, but the reality is that diabetes treatment choices often come down to health insurance. Both of the new drug classes cost from hundreds to around $1,000 a month, he said.
“Insurance coverage is probably the most important factor,” Blaise said. “Most people can’t afford these drugs if insurance doesn’t pay.”
Where such studies can help, is to encourage insurance plans to cover the new drugs: if they can prevent some heart disease and stroke, this can be a good financial investment.
The study, which was funded by the US Department of Veterans Affairs, has limitations. The main thing is that the patients were mostly white men. Both Rumi and Blaise said more research is needed to determine whether the findings are similar for women and people of other races.
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