Abstract
Two major trials, LEADER and SUSTAIN 6, published in 2016, reported the cardiovascular and microvascular benefits of liraglutide and semaglutide respectively. This communication describes the results of these trials, and analyses the subtle differences in their outcomes. While semaglutide significantly reduces the risk of non-fatal myocardial infarction (primary prevention), liraglutide reduces the risk of all-cause mortality and cardiovascular mortality (secondary prevention). Both drugs significantly improve renal outcomes, but semaglutide increased the risk of retinal events. The time taken to achieve benefit was much less (4-6 months) with semaglutide than with liraglutide (12–18 months). LEADER and SUSTAIN 6 have made 2016 a landmark year in the history of diabetes care. Their positive results will help promote better, comprehensive diabetes care, using minimal drugs (therapeutic parsimony), encourage use of rational combinations to improve outcomes, and stimulate exaptation of these drugs for non-glycemic purposes.
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