Researchers at Case Western Reserve are calling for a paradigm shift in treatment of type 2 diabetes, after four clinical trials suggest that more attention to reducing the risk of cardiovascular disease can improve patient outcomes. Currently, treatment generally concentrates on controlling blood sugar levels, but the Case Western trials found that using medications that control sugar but also reduce the risk of heart disease and stroke pays dividends.
“Strong evidence provided by the four recent trials published within the past 1.5 to 2 years in the New England Journal of Medicine has shown that some of the modern available therapeutic agents that control blood glucose also help reduce the risk for cardiovascular disease,” said Faramarz Ismail-Beigi, MD, PhD, Professor of Medicine at Case Western Reserve University.
Ismail-Beigi helped conduct three of the four clinical trials, and he and his collaborators recently reviewed trial results in the Journal of General Internal Medicine. The trials each tested a blood sugar-lowering medication — pioglitazone, empagliflozin, liraglutide, or semaglutide — but recruited patients with heart disease or stroke. The goal was to determine whether or not the drugs were safe, but in each study, researchers were surprised to find participants with or at risk of type 2 diabetes also experienced cardiovascular improvements.
“For the first time we have seen glucose-lowering medications that can improve cardiovascular outcomes,” Ismail-Beigi said. “It is highly possible that newer agents in these classes of medications, used singly or in combination, will prove to be more efficacious in the management of type 2 diabetes and prevention of cardiovascular disease, even in patients at earlier stages of the disease process.”
By contrast, previous studies focused on tight control of blood sugar have not shown major cardiovascular benefits for diabetes patients. “Strict control of blood glucose levels has shown minor, if any, positive effect on prevention of cardiovascular disease,” said Ismail-Beigi. “In fact, a large NIH-funded clinical trial on type 2 diabetes management failed to show that strict control of blood glucose levels had any positive effect on cardiovascular outcomes or mortality, and in fact, may be harmful.”
The new trial results could help address a major dilemma for clinicians looking for ways to control heart disease and reduce mortality, while simultaneously managing blood glucose in patients with type 2 diabetes.