‘Several diabetic meds have added benefits’
Clinical trials indicate heart benefits, quality of life and weight
OHIO, Dec 19: In recent years, it has come to light that several diabetic medications may have important health benefits in addition to controlling blood sugar, thanks to safety testing requirements imposed by the Food and Drug Administration (FDA). Patients should be aware of these, says an endocrinology physician at a top US hospital.
Marwan Hamaty, MD, who specializes in endocrinology and diabetes at Cleveland Clinic in Ohio, has pointed out that these additional positive outcomes occur in areas where further help is most needed amongst patients with diabetes, such as strokes and heart disease.
“Cardiovascular disease is the leading cause of death in patients with diabetes type 2. Not all patients with diabetes have the same risk of developing it, as it will also depend on the extent of comorbidities such as the duration of diabetes, presence of high blood pressure, excess lipids in the blood, chronic kidney disease, smoking as well as family history of a cardiovascular event (stroke or heart attack),” he says.
“When someone is diagnosed with diabetes, the standard care is prescribing metformin – a type of medication sold under various brand names – and counselling them on lifestyle issues such as adopting a healthier diet and exercising regularly. Lifestyle management on its own have been shown to significantly improve cardiovascular risk. When it comes to cardiovascular risk, every way of additional help is desired and needed. There is a strong case to be made that the newer classes of medications should be prescribed for people at high risk and for other people with lower riskas secondor third-line therapies (when metformin and lifestyle management are not enough).”
Dr Hamaty points out that patients should be aware of the recent findings. “Patients should raise and discuss the potential benefits and risks of each medication with their doctors, and make sure the doctor is aware of any other factors that could impact their treatment, such as a family history of a certain disease.
“In addition, if the doctor suggests one of these newer classes of medications for the patient, it is important that patients know of the potential benefits as well as side effects so they will be motivated to take them properly as prescribed.”
Regarding the specific medications and what the additional benefits are, Dr Hamaty says that, speaking generally, some of the medications tested show a reduction in death from heart attacks and strokes. These medications come from two main family of drugs: glucagon-like peptide-1 (GLP-1) receptor agonists and sodium-glucose transporter (SGLT) 2 inhibitors.
He cautions not all medications in a family of medicines will have the exact same benefits though. In addition, research results are not identical, which could be due to a multitude of factors such as study design, different populations, differences related directly to the medications and so on.
Strokes
The GLP-1 receptor agonists that appeared to show fewer incidents of dying from strokes or heart attacks include those with the chemical names of liraglutide and dulaglutide. Both medications also help with some weight loss. Additional unpublished information from studieson liraglutide showed maintaining good health-related quality of life while living longer after cardiovascular events (Information were presented at an American Diabetes Association meeting).
As for the SGLT 2 inhibitors, empagliflozin had the cleanest set of information which showed reduced risk of death from heart – or vascular-related problems. Canagliflozin showed similar findings. Information related to both medications showed potential reduction of hospital admissions because of heart failure and possibly protecting the kidneys. They are being evaluated further to determine their benefits in treating heart failure and diabetic kidney diseases. Dapagliflozin showed reduced heart failure in both people with and without diabetes, although it can only be prescribed for people with diabetes at this stage.
Dr Hamaty reports that patients at his clinic in the US tend to be more aware of the additional potential benefits because the US is one of two countries in the world that allowed to advertise brand name medications along with their side effects and benefits direct to the public.
He says “In general, when we see patients with heart or vascular disease, we favor one of those medications in the two families that have shown benefits in studies to help with heart conditions. Patients can research reputable sources online and discuss these in full with their physicians to find out which medication and family of medications will be most safe and beneficial for them.” – Cleveland Clinic Corporate Communication