From: Cardiovascular outcomes trials: a paradigm shift in the current management of type 2 diabetes
Guidelines | Selected recommendations for CVD management based on diabetes CVOTs |
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ADA 2022 | For patients with T2D who have established ASCVD or high / very high CV risk, SGLT2 inhibitors or GLP-1 RA with proven cardiovascular benefit are recommended as part of glycaemic management:* • Either a GLP-1 RA with proven CVD benefit or an SGLT2 inhibitor with proven CVD benefit • If further intensification is required or the patient is now unable to tolerate a GLP-1 RA and/or SGLT2 inhibitor choose agents demonstrating CV safety; consider adding the other class (GLP-1 RA or SGLT2 inhibitor) with proven CVD benefit† |
ACC 2020 | For patients with T2D who have established or high risk of ASCVD consider an SGLT2 inhibitor or GLP-1 RA with proven CV benefit |
ADA and EASD 2019 | For patients with T2D who have established ASCVD, an SGLT2 inhibitor or GLP-1 RA with proven cardiovascular benefit is recommended as part of glycaemic management: • First-line therapy is metformin • Add an GLP-1 RA with proven CVD benefit or, if eGFR is adequate, an SGLT2 inhibitor with proven CVD benefit • If further intensification is required or the patient is now unable to tolerate a GLP-1 RA and/or SGLT2 inhibitor, choose agents demonstrating CV safety† |
ESC (in association with EASD) 2019 | Consider CV risk independently of Hb1Ac; for patients with T2D who have ASCVD, or high/very high CV risk (target organ damage or multiple risk factors) • SGLT2 inhibitor or GLP-1 RA (either as first add-on to metformin or as monotherapy; however, drug labels stipulate that metformin should be first line) • If HbA1c is above target, consider adding the other class (GLP-1 RA or SGLT2i) with proven CVD benefit |