Which drug classes are used in the treatment of type 2 diabetes mellitus (DM), and what are their cardiovascular effects?

Updated: Sep 27, 2021
  • Author: Romesh Khardori, MD, PhD, FACP; Chief Editor: George T Griffing, MD  more...
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Early initiation of pharmacologic therapy is associated with improved glycemic control and reduced long-term complications in type 2 diabetes. Drug classes used for the treatment of type 2 diabetes include the following:

  • Biguanides

  • Sulfonylureas

  • Meglitinide derivatives

  • Alpha-glucosidase inhibitors

  • Thiazolidinediones (TZDs)

  • Glucagonlike peptide–1 (GLP-1) agonists

  • Dipeptidyl peptidase IV (DPP-4) inhibitors

  • Selective sodium-glucose transporter–2 (SGLT-2) inhibitors

  • Nonsteroidal mineralocorticoid receptor (MR) antagonists

  • Insulins

  • Amylinomimetics

  • Bile acid sequestrants

  • Dopamine agonists

A literature review by Alfayez et al indicated that GLP-1 agonists, DPP-4 inhibitors, and SGLT-2 inhibitors put patients with type 2 diabetes at no additional cardiovascular risk. Moreover, patients taking GLP-1 agonists actually showed significant reduction in such risk, while those on SGLT-2 inhibitors demonstrated a significant decrease in hospitalization for heart failure events. [172]  

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