The Landscape of Glucose-Lowering Therapy and Cardiovascular Outcomes: From Barren Land to Metropolis

<div>Suggested algorithm for pharmacotherapy in T2D. <svg height="10.1524pt" id="M18" style="vertical-align:-0.04990005pt" version="1.1" viewbox="-0.0498162 -10.1025 6.17869 10.1524" width="6.17869pt" xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink"><g transform="matrix(.0091,0,0,-0.0091,0,-5.741)"><path d="M486 158C486 177 478 202 466 220C413 228 386 236 336 262C386 288 413 297 466 304C478 323 486 347 485 366C470 376 444 381 422 380C389 338 368 319 321 288C323 345 329 372 349 422C339 442 322 461 305 470C289 461 271 442 262 422C281 372 287 345 290 288C243 319 222 338 189 380C167 381 142 376 125 366C125 347 133 322 145 304C198 296 225 288 275 262C225 236 198 227 145 220C133 201 125 177 126 158C141 148 167 143 189 144C222 186 243 205 290 236C288 179 282 152 262 102C272 82 289 63 306 54C322 63 340 82 350 102C330 152 324 179 321 236C368 205 390 186 422 144C444 143 470 148 486 158Z" id="g50-43"></path></g></svg>Agent-specific. <svg height="10.1524pt" id="M19" style="vertical-align:-0.04990005pt" version="1.1" viewbox="-0.0498162 -10.1025 11.7596 10.1524" width="11.7596pt" xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink"><g transform="matrix(.0091,0,0,-0.0091,0,-5.741)"><path d="M486 158C486 177 478 202 466 220C413 228 386 236 336 262C386 288 413 297 466 304C478 323 486 347 485 366C470 376 444 381 422 380C389 338 368 319 321 288C323 345 329 372 349 422C339 442 322 461 305 470C289 461 271 442 262 422C281 372 287 345 290 288C243 319 222 338 189 380C167 381 142 376 125 366C125 347 133 322 145 304C198 296 225 288 275 262C225 236 198 227 145 220C133 201 125 177 126 158C141 148 167 143 189 144C222 186 243 205 290 236C288 179 282 152 262 102C272 82 289 63 306 54C322 63 340 82 350 102C330 152 324 179 321 236C368 205 390 186 422 144C444 143 470 148 486 158Z" id="g50-43"></path></g><g transform="matrix(.0091,0,0,-0.0091,5.56,-5.741)"><path d="M486 158C486 177 478 202 466 220C413 228 386 236 336 262C386 288 413 297 466 304C478 323 486 347 485 366C470 376 444 381 422 380C389 338 368 319 321 288C323 345 329 372 349 422C339 442 322 461 305 470C289 461 271 442 262 422C281 372 287 345 290 288C243 319 222 338 189 380C167 381 142 376 125 366C125 347 133 322 145 304C198 296 225 288 275 262C225 236 198 227 145 220C133 201 125 177 126 158C141 148 167 143 189 144C222 186 243 205 290 236C288 179 282 152 262 102C272 82 289 63 306 54C322 63 340 82 350 102C330 152 324 179 321 236C368 205 390 186 422 144C444 143 470 148 486 158Z" id="g50-43"></path></g></svg>Grade A evidence with glargine and degludec. <svg height="11.5773pt" id="M20" style="vertical-align:-0.04979992pt" version="1.1" viewbox="-0.0498162 -11.5275 5.04606 11.5773" width="5.04606pt" xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink"><g transform="matrix(.0091,0,0,-0.0091,0,-5.741)"><path d="M457 455H370L403 612H360L326 455H218L252 612H210L175 455H77L68 394H161L132 257H31L20 196H117L77 19H120L159 196H268L230 19H272L311 196H402L412 257H325L355 394H447L457 455ZM313 394L283 257H175L204 394H313Z" id="g58-33"></path></g></svg>Effect reported for canagliflozin. <svg height="11.8878pt" id="M21" style="vertical-align:-0.04979992pt" version="1.1" viewbox="-0.0498162 -11.838 7.21084 11.8878" width="7.21084pt" xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink"><g transform="matrix(.0091,0,0,-0.0091,0,-5.741)"><path d="M724 428H489V396C558 388 570 377 552 332C533 288 517 255 494 220C431 283 362 343 329 370C366 395 388 414 407 430C430 449 449 478 449 518C449 598 382 657 300 657C209 657 133 590 133 499C133 444 161 403 204 363C116 299 54 261 54 169C54 81 127 -14 255 -14C327 -14 396 20 468 116C500 84 539 36 553 22C565 8 621 -14 677 -19L684 -8C652 49 565 147 521 191C557 244 580 284 607 323C640 373 654 388 724 396V428ZM288 619C337 619 373 573 373 516C373 465 347 427 300 392C236 437 207 471 207 522C207 579 241 619 288 619ZM282 57C214 57 142 105 142 197C142 246 168 291 233 338C329 262 390 203 441 146C409 101 349 57 282 57Z" id="g58-36"></path></g></svg>Not among the FDA-approved classes of GLT, however potential advantage in heart failure. <svg height="12.2304pt" id="M22" style="vertical-align:-0.04990005pt" version="1.1" viewbox="-0.0498162 -12.1805 4.98213 12.2304" width="4.98213pt" xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink"><g transform="matrix(.0091,0,0,-0.0091,0,-5.741)"><path d="M263 363V584C343 572 363 521 380 464L408 470C399 526 392 562 387 596C376 598 367 601 353 604C328 612 296 617 263 617V693H228V615C122 603 67 532 67 453C67 376 123 329 193 300L228 284V41C132 52 93 131 75 189L45 181C54 130 66 71 73 50C113 24 170 9 228 9V-76H263V11C370 24 434 90 434 185C434 275 367 325 292 352L263 363ZM228 376C171 398 136 431 136 484C136 530 164 578 228 584V376ZM263 272L275 267C345 236 359 196 359 150C359 96 325 50 263 42V272Z"></path></g></svg>Cost may be a significant consideration. SGLT2i: sodium-glucose cotransport 2 inhibitor; GLP-1 RA: glucagonlike peptide-1 receptor agonist; DPP-4 i: dipeptidyl peptidase-4 inhibitor; SU: sulfonylurea; TZD: thiazolidinedione; AGi: alpha glucosidase inhibitor; ARNI: Angiotensin Receptor blocker Neprilysin Inhibitor.</div>

BioMed Research International

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Figure 2

Figure 2: The Landscape of Glucose-Lowering Therapy and Cardiovascular Outcomes: From Barren Land to Metropolis 