There is little evidence that most diabetes drugs, including metformin, sulfonylureas, and DPP-4 Inhibitors (gliptins), lower cardiovascular mortality in people with diabetes.
GLP1 agonists have some benefit in terms of lowering the number of deaths from cardiovascular disease in people with diabetes, but the medication’s benefits took “quite some time to accrue”, says Professor Andrew Sindone, the director of heart failure and department of cardiac rehabilitation at Concord Hospital.
“The big revolution in managing diabetes and improving cardiovascular mortality happened in September 2015 when the SGLT2 Inhibitors in the EMPA-REG OUTCOME study showed a huge improvement in mortality,” he says.
This study used empagliflozin, which is a drug that causes glycosuria.
People on this drug lose about the equivalent of 18 sugar cubes in the urine every day.
They lose weight, their blood pressure comes down, their heart rate lowers, they get a 38% reduction in cardiovascular mortality and a 27% reduction in overall mortality, says Professor Sindone.
“This is the first time ever that any diabetic medication has shown such huge benefits,” he says.
“And it’s not really driven by the glucose. The HbA1c comes down a little but the benefit seems to be cardiovascular. I tell people this is a cardiovascular drug, it just happens to lower blood glucose.
“A lot of diabetes medications, including insulin, make people put on weight. So this is going to revolutionise diabetes.”