b'New Focus in the Fight to Reduce CV Risks in Type 2 Diabetescombined with any one of the preferred sixtreatmentoptions:sulfonylurea,Patients want effective treatment optionsthiazolidinedione,DPP-4inhibitor, SGLT2 inhibitor, GLP-1 RA, or basal insulin; the choice of which agent tofor diabetes that are as minimally intrusive addisbasedondrug-specificeffects and patient factors. on their lives as possible . The 2020 ADA guidance went on to state,AlthoughmostpatientspreferLisa Yanoff, MD, of the FDAoral medications to drugs that need to be injected, the eventual need for the greaterpotencyofinjectablemedica- control of blood sugar in adult patientscardiovascularbenefitsofanti-gly-tions is common, particularly in peoplewith Type 2 diabetes, along with dietcemicmedicationscouldpotentially with a longer duration of diabetes. Theandexercise.Rybelsuswasthefirstreduce the morbidity and mortality of addition of basal insulin, either humanGLP-1receptorproteintreatmentboth diseases at once. 3NPH or one of the long-acting insulinapproved for use in the United StatesThe treatment of patients with Type analogs,tooralagentregimensisathat does not need to be injected.2 diabetes mellitus and cardiovascular well-established approach that is effec- Patientswanteffectivetreatmentdisease is rapidly advancing. In particu-tiveformanypatients.Inaddition,options for diabetes that are as mini- lar, the sodium-glucose cotransporter-2 recentevidencesupportstheutilitymally intrusive on their lives as possible,(SGLT2)inhibitorsandglucagon-like ofGLP-1RAsinpatientsnotreach- andtheFDAwelcomestheadvance- peptide-1(GLP-1)receptoragonists ing glycemic targets with use of non- mentofnewtherapeuticoptionsthathave demonstrated cardiovascular ben-GLP-1 RA oral agent regimens. can make it easier for patients to controlefit by reducing major adverse cardio-It pointed out that new options aretheir condition, explained Lisa Yanoff,vascular events and cardiovascular mor-available,however.WhilemostMD,actingdirectoroftheDivisiontality, according to the report. Future GLP-1RAproductsareinjectable,ofMetabolismandEndocrinologydirectionsofthetreatmentofType2 an oral formulation of semaglutide isProducts in the FDAs Center for Drugdiabetes and cardiovascular disease will now commercially available. In trialsEvaluation and Research. Before thisfocus on targeting and preventing dia-comparing the addition of an inject- approval, patients did not have an oralbetic cardiomyopathy and further defin-able GLP-1 RAs or insulin in patientsGLP1 option to treat their Type 2 dia- ing the role of SGLT2 inhibitors and of needingfurtherglucoselowering,betes,andnowpatientswillhaveaGLP-1receptoragonistsinadditional theefficacyofthetwotreatmentsnew option for treating Type 2 diabetespatient populations.was similar. However, GLP-1 RAs inwithout injections. 1 Reaven PD, Emanuele NV, Wiitala WL, et these trials had a lower risk of hypo- Areviewfromauthorsattheal. Intensive Glucose Control in Patients with glycemiaandbeneficialeffectsonRichmond,VA,VAMCandVirginiaType 2 Diabetes15-Year Follow-up. N Engl body weight compared with insulin,CommonwealthUniversityHealthJ Med. 2019;380(23):2215-2224. doi:10.1056/albeitwithgreatergastrointestinalSystemrecentlypointedoutthatNEJMoa1806802sideeffects.Thus,trialresultssup- pathophysiological and clinical asso- 2American Diabetes Association. 2. Classifica-port injectable GLP-1 RAs as the pre- ciations between diabetes and cardio- tion and Diagnosis of Diabetes: Standards of ferred option for patients requiring thevascular disease have been the subjectMedical Care in Diabetes-2020. Diabetes Care. potency of an injectable therapy forof multiple studies, most recently cul- 2020;43(Suppl 1):S14-S31. doi:10.2337/dc20-glucose control. However, high costsminating in large trials of several newS002 and tolerability issues are importantanti-glycemicagentsbeingfoundto3Choxi R, Roy S, Stamatouli A, Mayer SB, Jovin barriers to the use of GLP-1 RAs. conferadditionalcardiovascularriskIS. Type 2 diabetes mellitus and cardiovascular disease: focus on the effect of antihypergly-InSeptember2019,theU.S.Foodreduction. cemic treatments on cardiovascular outcomes andDrugAdministrationannouncedInanarticleinExpertReviewsof[published online ahead of print, 2020 Apr itsapprovalofsemaglutideoraltab- CardiovascularTherapy,theauthors24]. Expert Rev Cardiovasc Ther. 2020;1-13. doilets, marketed as Rybelsus, to improveemphasizedthatbetterunderstanding:10.1080/14779072.2020.1756778322020 COMPENDIUM OF FEDERAL MEDICINE'