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Changing the approach to type 2 diabetes treatment: A comparison of glucagon‐like peptide‐1 receptor agonists and sulphonylureas across the continuum of care

Despite the importance of individualised strategies for patients with type 2 diabetes mellitus (T2DM) and the availability of alternative treatments, including glucagon‐like peptide‐1 receptor agonists (GLP‐1 RAs), sulphonylureas are still widely used in practice. Clinical evidence shows that GLP‐1...

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Autores principales: Orsini Federici, Marco, Gentilella, Raffaella, Corcos, Antonella, Torre, Enrico, Genovese, Stefano
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8519155/
https://www.ncbi.nlm.nih.gov/pubmed/33900667
http://dx.doi.org/10.1002/dmrr.3434
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author Orsini Federici, Marco
Gentilella, Raffaella
Corcos, Antonella
Torre, Enrico
Genovese, Stefano
author_facet Orsini Federici, Marco
Gentilella, Raffaella
Corcos, Antonella
Torre, Enrico
Genovese, Stefano
author_sort Orsini Federici, Marco
collection PubMed
description Despite the importance of individualised strategies for patients with type 2 diabetes mellitus (T2DM) and the availability of alternative treatments, including glucagon‐like peptide‐1 receptor agonists (GLP‐1 RAs), sulphonylureas are still widely used in practice. Clinical evidence shows that GLP‐1 RAs may provide better and more durable glycaemic control than sulphonylureas, with lower risk of hypoglycaemia. Other reported benefits of GLP‐1 RAs include weight loss rather than weight gain (as observed with sulphonylureas), blood pressure reduction and improvement in lipid profiles. In general, the main adverse events with GLP‐1 RAs are gastrointestinal in nature. The respective modes of action of GLP‐1 RAs and sulphonylureas contribute to differences in the durability of glycaemic control (related to effects on beta‐cells) and effects on body weight. Moreover, the glucose‐dependent mode of action of GLP‐1 RAs, which favours a low incidence of hypoglycaemia, contrasts with the glucose‐independent mode of action of sulphonylureas. Evidence from cardiovascular outcomes trials indicates a consistent finding of cardiovascular safety across the GLP‐1 RAs and suggests a class benefit for the long‐acting GLP‐1 RAs in reducing three‐point major adverse cardiovascular events, cardiovascular mortality and all‐cause mortality. In contrast, potential concerns relating to an increased incidence of adverse cardiovascular events with sulphonylureas have yet to be fully resolved. Recent updates to management guidelines recommend that treatment selection for patients with T2DM should consider clinical trial evidence of cardiovascular safety. Available evidence suggests that this selection should give preference to GLP‐1 RAs over sulphonylureas, especially for patients at high cardiovascular risk.
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spelling pubmed-85191552021-10-22 Changing the approach to type 2 diabetes treatment: A comparison of glucagon‐like peptide‐1 receptor agonists and sulphonylureas across the continuum of care Orsini Federici, Marco Gentilella, Raffaella Corcos, Antonella Torre, Enrico Genovese, Stefano Diabetes Metab Res Rev Review Articles Despite the importance of individualised strategies for patients with type 2 diabetes mellitus (T2DM) and the availability of alternative treatments, including glucagon‐like peptide‐1 receptor agonists (GLP‐1 RAs), sulphonylureas are still widely used in practice. Clinical evidence shows that GLP‐1 RAs may provide better and more durable glycaemic control than sulphonylureas, with lower risk of hypoglycaemia. Other reported benefits of GLP‐1 RAs include weight loss rather than weight gain (as observed with sulphonylureas), blood pressure reduction and improvement in lipid profiles. In general, the main adverse events with GLP‐1 RAs are gastrointestinal in nature. The respective modes of action of GLP‐1 RAs and sulphonylureas contribute to differences in the durability of glycaemic control (related to effects on beta‐cells) and effects on body weight. Moreover, the glucose‐dependent mode of action of GLP‐1 RAs, which favours a low incidence of hypoglycaemia, contrasts with the glucose‐independent mode of action of sulphonylureas. Evidence from cardiovascular outcomes trials indicates a consistent finding of cardiovascular safety across the GLP‐1 RAs and suggests a class benefit for the long‐acting GLP‐1 RAs in reducing three‐point major adverse cardiovascular events, cardiovascular mortality and all‐cause mortality. In contrast, potential concerns relating to an increased incidence of adverse cardiovascular events with sulphonylureas have yet to be fully resolved. Recent updates to management guidelines recommend that treatment selection for patients with T2DM should consider clinical trial evidence of cardiovascular safety. Available evidence suggests that this selection should give preference to GLP‐1 RAs over sulphonylureas, especially for patients at high cardiovascular risk. John Wiley and Sons Inc. 2021-02-07 2021-10 /pmc/articles/PMC8519155/ /pubmed/33900667 http://dx.doi.org/10.1002/dmrr.3434 Text en © 2021 Eli Lilly Italia Spa. Diabetes/Metabolism Research and Reviews published by John Wiley & Sons Ltd. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Review Articles
Orsini Federici, Marco
Gentilella, Raffaella
Corcos, Antonella
Torre, Enrico
Genovese, Stefano
Changing the approach to type 2 diabetes treatment: A comparison of glucagon‐like peptide‐1 receptor agonists and sulphonylureas across the continuum of care
title Changing the approach to type 2 diabetes treatment: A comparison of glucagon‐like peptide‐1 receptor agonists and sulphonylureas across the continuum of care
title_full Changing the approach to type 2 diabetes treatment: A comparison of glucagon‐like peptide‐1 receptor agonists and sulphonylureas across the continuum of care
title_fullStr Changing the approach to type 2 diabetes treatment: A comparison of glucagon‐like peptide‐1 receptor agonists and sulphonylureas across the continuum of care
title_full_unstemmed Changing the approach to type 2 diabetes treatment: A comparison of glucagon‐like peptide‐1 receptor agonists and sulphonylureas across the continuum of care
title_short Changing the approach to type 2 diabetes treatment: A comparison of glucagon‐like peptide‐1 receptor agonists and sulphonylureas across the continuum of care
title_sort changing the approach to type 2 diabetes treatment: a comparison of glucagon‐like peptide‐1 receptor agonists and sulphonylureas across the continuum of care
topic Review Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8519155/
https://www.ncbi.nlm.nih.gov/pubmed/33900667
http://dx.doi.org/10.1002/dmrr.3434
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