Antihyperglycemic Therapy

Jan 5, 2019

John S. is a 63-year-old Caucasian man with significant abdominal obesity, type 2 diabetes, hypertension, and dyslipidemia as well. On the basis of an exercise stress test, John was recently diagnosed with silent ischemia. John’s current medications include metformin, a DPP-4 inhibitor, an ACE inhibitor/HCTZ agent, a calcium channel blocker, a high-dose statin, and ezetimibe. John’s relevant physical exam and laboratory findings are as follows:

BMI	34.8 kg/m2
Blood pressure	140/86 mm Hg
HbA1C	7.2%
Total cholesterol	150 mg/dL
LDL-C	79 mg/dL
HDL-C	42 mg/dL
Triglycerides	145 mg/dL
non-HDL-C	118 mg/dL
eGFR	65 mL/min/1.73 m2
ACR	100 mg albumin/g creatinine

You explain John’s options for antihyperglycemic therapy. Which of the following answers most accurately describes the extraglycemic benefits of the different options?

	A. The GLP-1 receptor agonists may improve endothelial function and reduce infarct size and the SGLT2 inhibitors are likely to improve arterial blood flow.
	B. The DPP-4 inhibitors are not safe for people with cardiovascular disease, while the proven cardiovascular benefits of GLP-1 receptor agonists are consistent across the class.
	C. DPP-4 inhibitors and SGLT2 inhibitors both reduce blood pressure, which accounts for their similar effects on heart failure.
	D. The cardiovascular benefits of both the GLP-1 receptor agonists and SGLT2 inhibitors derive mainly from their effects on weight.

Correct

Correct Answer: a. The GLP-1 receptor agonists may improve endothelial function and reduce infarct size and the SGLT2 inhibitors are likely to improve arterial blood flow.

Incorrect