Researchers call for paradigm shift in treating type 2 diabetes

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Existing type 2 diabetes medications that lower blood sugar levels can also reduce the risk of heart disease or stroke, researchers have found.
The results from four different studies have shown that using certain medications that offer both glucose control and reduce the risk of heart problems.
The review, led by Dr Faramarz Ismail-Beigi, Louis Stokes Cleveland VA Medical Center, looked at the effects of diabetes medications including Actos (pioglitazone), Jardiance (empagliflozin), Victoza (liraglutide), or semaglutide.
The results of four studies that took place within the last one and a half years were reviewed. The aim of the studies was to determine the safety of the drugs, but in each study participants with or at risk of type 2 diabetes experienced cardiovascular improvements.
“For the first time we have seen glucose-lowering medications that can improve cardiovascular outcomes,” said Ismail-Beigi.
“It is highly possible that newer agents in these classes of medications, used singly or in combination, will prove to be more efficacious in the management of type 2 diabetes and prevention of cardiovascular disease, even in patients at earlier stages of the disease process.”
Previous research looking at current treatments had always focused on tight glucose control, Ismail-Beigi says, but not major cardiovascular benefits for people with diabetes. This is despite heart disease being a major cause of death around the world, which is only made worse by type 2 diabetes.
The study team says that focusing only on blood glucose control can leave people at higher risk of developing heart disease. Their new findings, however, could address a major dilemma for healthcare professionals looking to achieve both improved CVD risks and blood sugar control.
“Our review focuses on the need for a paradigm shift on how we should think about management of type 2 diabetes. I believe it will necessitate a rethinking of goals and approaches by guideline committees.
“Based on this evidence, we propose that we must shift from our previous paradigm with its monocular focus on control of blood glucose and HbA1c, to one of control of blood glucose plus preventing cardiovascular disease and death from cardiovascular causes.”
The results of the study have been published in the Journal of General Internal Medicine.