Aspects of the safety of hypoglycemic drugs according to the results of clinical trials

Abstract

The results and the degree of safety of various groups of hypoglycemic drugs are presented. The current work analyzes the safety of the use of glucagon-like peptide-1 (GLP-1) agonists, dipeptidyl peptidase-4 (iDPP-4) inhibitors, insulins, and inhibitors of sodium glucose cotransporter type 2 (iSGLT-2) according to clinical studies published in the scientific literature. Macrovascular complications in diabetes mellitus (DM) develop much earlier than microvascular complications and are the cause of death in 75–80% of patients. The safety of ongoing hypoglycemic therapy is based on the stabilization of its cardiovascular effect. GLP type 1 receptor agonists (lixisenatide) and DPP-4 idiopathic agonists (alogliptin) demonstrated a positive effect on the prognosis of patients with cardiovascular diseases. In addition to metformin, selective sodium-glucose cotransporter type 2 inhibitors, in particular empagliflozin and GLP type 1 analogs, act as first-line drugs from the position of cardiovascular safety in the treatment of patients with type 2 diabetes with a very high cardiovascular risk (liraglutide). The action of iSGLT-2 is glucose-dependent, which leads to a lower risk of hypoglycemia and, accordingly, cardiovascular safety for this class of drugs. Empagliflozin prevents the progression of cardiovascular disease in patients with type 2 diabetes, with heart failure with reduced ejection fraction, regardless of the presence of diabetes, providing a holistic approach to the management of patients with a cardiac profile.