Journal Article

From glucose lowering agents to disease/diabetes modifying drugs: a “SIMPLE” approach for the treatment of type 2 diabetes

Ralph A. DeFronzo, Meir Schechter, Lawrence A. Leiter, Itamar Raz, Antonio Ceriello, Ofri Mosenzon, Stefano Del Prato

2021

Overview

During the last decade we experienced a surge in the number of glucose lowering agents that can be used to treat patients with type 2 diabetes. Especially important are the discoveries that sodium glucose co-transporter type 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1 RA) improve patients’ cardiovascular and renal outcomes. Accordingly, various medical associations have updated their guidelines for the treatment of diabetes in this new era. Though not agreeing on every issue, these position-statements generally share a detailed and often complex workflow that may be too complicated for the busy and overworked primary care setting, where the majority of patients with type 2 diabetes are managed in many countries. Other guidelines, generally those from the cardiology associations focus primarily on the population of patients with high risk for or pre-existing cardiovascular disease, which represent only the minority of patients with type 2 diabetes. We believe that we should re-define SGLT2i and GLP-1 RA as diabetes/disease modifying drugs (DMDs) given the recent evidence of their cardiovascular and renal benefits. Based on this definition we have designed a SIMPLE approach in order to assist primary care teams in selecting the most appropriate therapy for their patients. We believe that most subjects newly diagnosed with type 2 diabetes should initiate early combination therapy with metformin and a prognosis changing DMD. The decision whether to use GLP-1 RA or SGLT2i should be made based on specific patient’s risk factors and preferences. Importantly, DMDs are known to have a generally safe side-effect profile, with lower risk for hypoglycemia and weight gain, further promoting their wider usage. Early combination therapy with DMDs may improve the multiple pathophysiological abnormalities responsible for type 2 diabetes and its complications, thus resulting in the greatest long term benefits.

• Publisher: Springer Science and Business Media LLC,BioMed Central,Springer Nature B.V,BMC
• Subject: Angiology / Biomarkers / Blood Glucose / Cardiology / Cardiovascular disease / Cardiovascular diseases / Clinical approach / Clinical approach; Diabetes/Disease Modifying Drugs (DMDs); Type 2 Diabetes; Biomarkers; Blood Glucose; Clinical Decision-Making; Diabetes Mellitus, Type 2; Glucagon-Like Peptide-1 Receptor; Glycated Hemoglobin A; Humans; Hypoglycemic Agents; Incretins; Patient Selection; Primary Health Care; Sodium-Glucose Transporter 2 Inhibitors; Terminology as Topic; Treatment Outcome; Decision Support Techniques; Glycemic Control / Clinical Decision-Making / Decision Support Techniques / Diabetes / Diabetes mellitus (non-insulin dependent) / Diabetes Mellitus, Type 2 / Diabetes/Disease Modifying Drugs (DMDs) / Diseases of the circulatory (Cardiovascular) system / Drugs / GLP-1 receptor agonists / Glucagon / Glucagon-like peptide 1 / Glucagon-Like Peptide-1 Receptor / Glucose / Glucose transporter / Glycated Hemoglobin / Glycemic Control / Heart failure / Humans / Hypoglycemia / Hypoglycemic Agents / Incretins / Insulin / Medicine / Medicine & Public Health / Metformin / Patient Selection / Patients / Pharmaceutical industry / Physiology / Primary care / Primary Health Care / RC666-701 / Review / Risk factors / Sodium-Glucose Transporter 2 Inhibitors / Teams / Terminology as Topic / Treatment Outcome / Type 2 Diabetes