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

Table 5 Recommendations on the use of antidiabetic drugs

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	ESC/EASD	[40]
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	ESC	[41]
SGLT-2 inhibitor, GLP-1 agonists and metformin	Consistent with current ADA guideline	AHA	[39]

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

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