Using Newer Diabetes Agents: Assess the Most Pressing Need

This transcript has been edited for clarity.

Hi. I'm at the European Association for the Study of Diabetes meeting in Barcelona, and I'm going to talk about the use of diabetes medications to reduce the risk for cardiovascular disease (CVD), heart failure, and chronic kidney disease (CKD) in patients with diabetes.

A New Way of Thinking

There has been a huge paradigm shift now that we have medications that reduce glucose levels and the risks for other diabetes complications. The European Society of Cardiology came out with guidelines^[1] suggesting that in patients with known heart failure, CVD, or CKD, instead of using metformin as a first-line agent, we immediately jump to the use of an SGLT2 inhibitor or a GLP-1 receptor agonist.

Even though that seems quite shocking to me, since I'm very used to using metformin, we need to consider why we use different agents and in whom we should use them. Metformin is a great drug. It costs pennies a pill, it has a long track record, we know what's good and bad about it, and it lowers glucose levels. We also know that in almost all of the cardiovascular outcomes trials, many of the patients coming into the trials were already on metformin.