Diabetes Treatment Approach for ASCVD, HF, or CKD

Med (↓ HbA1C) Comments

GLP-1 receptor agonists (~1–2%)

↑ glc-depend. insulin secretion. Delay gastric emptying. Wt ↓, N/V. ↓ CVD/MI/stroke, esp. if ASCVD. ↓ prog of albuminuria. 1st line if est. ASCVD or high ASCVD risk (age >55, LVH, arterial stenosis >50%), regardless of A1c.

SGLT-2 inhibitors (~0.5–1%)

↑ glucosuria. Wt ↓. ↑ genital infxn. ? caution if PAD. ↓ CVD/HHF. ↓ prog. of renal disease. ± ↓ MI if ASCVD. 1st line if HF, proteinuric CKD, regardless of A1c.

Metformin (~1–1.5%)

↓ hepatic gluconeogenesis. Mild wt ↓. Rare lactic acidosis. Caution if GFR 30–45; contra. if <30. Poss CV benefit. Historically 1st line Rx, although some debate given benefit of GLP1RA & SGLT2i.

Explain by ChatGPT

• GLP-1 receptor agonists increase gluc-dependent insulin secretion, delay gastric emptying, and lead to weight decrease and decreased risk of CVD/MI/stroke, especially in ASCVD patients.
• SGLT-2 inhibitors increase glucosuria, lead to weight decrease, and decreased risk of CVD/HHF.
• Metformin decreases hepatic gluconeogenesis, leads to mild weight decrease, and has the potential to decrease the risk of CV disease.

窩的英文不太好

• GLP-1 受體激動劑增加 gluc 依賴性胰島素分泌，延遲胃排空，並導致體重減輕和 CVD/MI/中風風險降低，尤其是在 ASCVD 患者中。
• SGLT-2 抑製劑增加糖尿，導致體重下降，並降低 CVD/HHF 的風險。
• 二甲雙胍減少肝臟糖異生，導致輕度體重減輕，並有可能降低心血管疾病的風險。