[SGLT2 inhibitor or GLP-1 receptor agonist in a type 2 diabetic patient with cardiovascular disease ?]

André J Scheen, Nicolas Paquot
Revue Médicale Suisse 2018 August 22, 14 (615): 1460-1465
Sodium-glucose cotransporter type 2 inhibitors (SGLT2is), with empagliflozin in EMPA-REG OUTCOME, and glucagon-like peptide-1 receptor agonists (GLP-1RAs), with liraglutide in LEADER, have proven their ability to reduce major cardiovascular events and mortality in patients with type 2 diabetes and established cardiovascular disease. Thus clinicians have to choose between the two options in patients at high risk. The choice should be based upon a personalized approach, which has to take into account the drug properties, especially the tolerance profile, and patient's individual characteristics. In patients with heart failure, the added value of a SGLT2i appears obvious while in those with advanced renal insufficiency, current evidence favours the use of a GLP-1RA.

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