Abstract
Type 2 diabetes mellitus is a progressive disease, associated with multiple cardiovascular risk factors (obesity, hypertension, dyslipidemia) and with the development of micro- and macro-vascular complications. Several anti-diabetic drugs commonly used, such as sulfonylureas, thiazolidinediones and insulin induce weight gain and have modest or negative effects on cardiovascular risk factors and cardiovascular events. In this context, the GLP-1 receptor agonists (GLP-1 RA) instead have an important action on glycemic control and β-cell dysfunction, show favorable effects on body weight, hypertension and lipid profile, have a reduced risk of hypoglycemia and more recently have demonstrated clear benefits on major cardiovascular events, cardiovascular mortality and renal damage. In these years it has been an evolution on the role of the GLP-1 RA in the new paradigm of type 2 diabetes. For this reason the GLP-1 RA find place at any moment of the cardiovascular and renal continuum, from the initial one for controlling blood glucose and the different risk factors to the most advanced when cardiovascular damage is already present. The GLP-1 RA therefore represent a key elements in the management of patients with type 2 diabetes at any time in the natural history of the disease both for glycemic control and for the prevention of CV and renal events. KEY WORDS GLP-1 receptor agonists; type 2 diabetes; cardiovascular risk factors; cardiovascular disease; cardiovascular outcome trials.
Highlights
Il diabete mellito tipo 2 (DMT2) è una patologia progressiva, associata a multipli fattori di rischio cardiovascolare ed allo sviluppo di complicanze micro e macrovascolari
The GLP-1 receptor agonists (GLP-1 RA) instead have an important action on glycemic control and β-cell dysfunction, show favorable effects on body weight, hypertension and lipid profile, have a reduced risk of hypoglycemia and more recently have demonstrated clear benefits on major cardiovascular events, cardiovascular mortality and renal damage. In these years it has been an evolution on the role of the GLP-1 RA in the new paradigm of type 2 diabetes
Alla luce delle evidenze emerge chiaramente come in questi anni vi sia stata una evoluzione del ruolo dei GLP-1 RA nel nuovo paradigma del diabete tipo 2
Summary
Il diabete mellito tipo 2 (DMT2) è una patologia progressiva, associata a multipli fattori di rischio cardiovascolare (obesità, ipertensione arteriosa, dislipidemia) ed allo sviluppo di complicanze micro e macrovascolari. In realtà successivi studi hanno indicato una pari effetto anche dei GLP-1 RA a lunga durata d’azione sulla glicemia post-prandiale con un meccanismo diverso dagli short-acting e legato all’aumento dell’insulinemia e alla soppressione del glucagone(14).
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