Building Competency in Diabetes Education THE ESSENTIALS

TREATMENT MODALITIES: PHARMACOLOGICAL THERAPIES | 6-

Figure 2.1 summarizes the evidence which demonstrates certain GLP-1 RA and SGLT2i agents can reduce the risks of MACE (major adverse cardiovascular events), HHF (hospitalization for heart failure) and progression of nephropathy, where MACE is defined as nonfatal myocardial infarction (MI), nonfatal stroke or CV death. Secondary CV prevention in persons with ASCVD : GLP-1 RA evidence : In persons with established CVD, the most reliable evidence for CV benefit (lower risk of MACE) from individual clinical trials is: There is no evidence of CV benefit for lixisenatide (ELIXA). The CV benefits of exenatide-ER (EXSCEL) and oral semaglutide (PIONEER 6) remain unproven; with the clinical trial (SOUL) powered to investigate the CV benefits of oral semaglutide expected to be completed in 2024. SGLT2i evidence : Trials demonstrating statistical significance showing CV benefit remain unchanged from the 2018 CPGs allowing for the following to be recommended when eGFR > 30mL/min/1.73m 2 : • Empagliflozin 10mg/25mg (EMPA-REG OUTCOME) • Canagliflozin 100mg/300mg (CANVAS program, including CANVAS and CANVAS-R) • Liraglutide 1.8mg (LEADER) • Dulaglutide 1.5mg (REWIND) • Semaglutide 0.5mg or 1mg (SUSTAIN-6)