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Table 5 Recommendations on the use of antidiabetic drugs

From: Cardiovascular disease in type 2 diabetes mellitus: progress toward personalized management

Antidiabetic drugs choice Population Guideline References
SGLT-2 inhibitor and /or GLP-1 RA Patients with T2DM with established atherosclerotic CVD, or multiple risk factors for CVD or established kidney disease irrespective of additional glucose lowering and metformin use ADA [91]
SGLT-2 inhibitor Patients with T2DM and established HFrEF
Initiated with metformin Patients with T2DM and/or stable HF
Initiated with an SGLT-2 inhibitor or GLP-1 RA Patients with newly diagnosed T2DM and established atherosclerotic CVD, or very high risk factors for CVD before metformin use ESC/EASD [40]
Initiated with metformin Overweight patients with T2DM without CVD and at moderate CV risk
Metformin In persons with T2DM with atherosclerotic CVD ESC [41]
Initiated with an SGLT-2 inhibitor or GLP-1 RA In patients with T2DM without atherosclerotic CVD, HF, or chronic kidney disease
SGLT-2 inhibitor, GLP-1 agonists and metformin Consistent with current ADA guideline AHA [39]
  1. DM diabetes mellitus, CVD cardiovascular disease, T2DM type 2 diabetes mellitus, ASCVD atherosclerotic cardiovascular disease, ADA American Diabetes Association, ESC European Society of Cardiology, EASD European Association for the Study of Diabetes, HF heart failure, SGLT-2 sodium-glucose cotransporter -2, GLP-1 RA glucagon-like peptide-1 receptor agonist, ACC American College of Cardiology