Advances in type 2 diabetes therapy: a focus on cardiovascular and renal outcomes

Renata Libianto, Timothy ME Davis and Elif I Ekinci
Med J Aust 2020; 212 (3): . || doi: 10.5694/mja2.50472
Published online: 17 February 2020


  • Treatment options for type 2 diabetes have expanded. While metformin remains the first line treatment in most cases, choices for second line treatment now extend beyond sulfonylureas and include the sodium–glucose cotransporter 2 (SGLT2) inhibitors, glucagon‐like peptide 1 (GLP1) receptor agonists, and dipeptidyl peptidase 4 (DPP4) inhibitors.
  • SGLT2 inhibitors are recommended for people with atherosclerotic cardiovascular disease, heart failure or kidney disease. Diabetic ketoacidosis is an uncommon but important side effect; its occurrence can be minimised with appropriate patient education and management, especially during perioperative periods and times of illness.
  • GLP1 receptor agonists are recommended for people with atherosclerotic cardiovascular disease. Gastrointestinal side effects are common but are less prominent with the longer acting agents and can be minimised with slow titration of the shorter acting agents.
  • DPP4 inhibitors are generally well tolerated, but alogliptin and saxagliptin should be used with caution in people with risk factors for heart failure.
  • To optimise the management of type 2 diabetes, clinicians need to be aware of the pharmacological characteristics of each class of blood glucose‐lowering medications and of the effect on cardiovascular health and renal function, balanced by potential adverse effects.
  • Medications that have cardiovascular or renal benefits should be prescribed for patients with these comorbidities, and this is reflected in recent international guidelines.
  • Renata Libianto1
  • Timothy ME Davis2
  • Elif I Ekinci1,3

  • 1 Melbourne University, Melbourne, VIC
  • 2 University of Western Australia, Perth, WA
  • 3 Austin Health, Melbourne, VIC



Renata Libianto is supported by a National Health and Medical Research Council/National Heart Foundation of Australia postgraduate scholarship and by the Royal Australasian College of Physicians (RACP). Timothy Davis is supported by a Medical Research Future Fund Next Generation Clinical Researchers Program Practitioner Fellowship. Elif Ekinci has received grant funding from Viertel, RACP, Sir Edward Weary Dunlop Medical Research Foundation, and Diabetes Australia Research Program.

Competing interests:

Elif Ekinci's institute has received research funding from Novo Nordisk, Sanofi, GeNeuro and Dimerix. Timothy Davis has served on advisory boards for, and received research funding, speaker fees and travel assistance to attend meetings from, Merck Sharp and Dohme (manufacturer of sitagliptin and ertugliflozin), NovoNordisk (manufacturer of liraglutide and semaglutide), and Eli Lilly (manufacturer of dulaglutide). He has also served on advisory boards for, and received speaker fees and travel assistance to attend meetings from, AstraZeneca (manufacturer of saxagliptin, exenatide and dapagliflozin) and Boehringer Ingelheim (manufacturer of linagliptin and empagliflozin).


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