New NEJM article can serve as diabetes medication resource
The list of medication options to treat patients who have diabetes grows continually longer and longer. A new clinical practice review article published April 1 by Rita Rastogi Kalyani, MD, in The New England Journal of Medicine (NEJM), distills the newest trial results and guidelines into a systematic approach for the treatment of patients with diabetes.
The NEJM article can serve as an up-to-date resource for health care practitioners on glucose-lowering therapies, particularly to reduce the risk of cardiovascular disease for patients who have diabetes. People with type 2 diabetes are more than twice as likely to develop atherosclerotic cardiovascular disease and heart failure than people without the disease.
In the article, Kalyani includes comprehensive drug tables that detail A1C-lowering efficacy, route and frequency of administration, cost, effects on weight, risk of hypoglycemia, adverse effects, and clinical benefits—detailed information that can help health care providers chose the best glucose-lowering medication for patients with type 2 diabetes.
"Health care providers in primary care, endocrinology, cardiology, and nephrology are now prescribing these newer glucose-lowering drugs for their patients," Kalyani said in a news release. "Diabetes care will need to be increasingly collaborative in the future and, at its core, remain patient-centered."
In the article, Kalyani lists specific agents in two newer drug classes as beneficial for patients with diabetes who already show signs of cardiovascular disease.
"After metformin, which is widely considered the initial drug treatment for type 2 diabetes, specific drugs in the GLP-1 receptor agonist and SGLT2 inhibitor classes with demonstrated cardiovascular benefit should be considered as additional medications for patients who already have cardiovascular disease. This should be done irrespective of whether their A1C level is at target to reduce the risk of future cardiovascular events," said Kalyani.
Kalyani noted in the news release that the cardiovascular effects of older drugs remain uncertain because before 2008, FDA did not require large outcome trials for drugs after their introduction to the market.
The article also includes details about medications that offer additional benefits for patients with diabetes who have multiple cardiovascular disease risk factors, heart failure, and chronic kidney disease.
Loren Bonner, senior editor