Large cardiovascular outcome trials (CVOTs) have lent support to a cardiovascular protection with the use of SGLT2-inhibitors (SGLT2is) and GLP1-Receptor Agonists (GLP1-RAs) in subjects with type 2 diabetes. These two classes of novel glucose lowering agents have been shown to have a similar effect on the risk reduction of Major Adverse Cardiovascular Events (MACE: nonfatal myocardial infarction, nonfatal stroke, cardiovascular mortality). Nonetheless, they may not be simply interchangeable. Rather, careful evaluation of all the results of CVOTs leads identification of different effects that may allow profiling of the ideal individuals with T2DM who may benefit most from the use of one or the other class of agents. These differences include effect on heart failure, stroke and diabetic kidney disease that have prompt recent guidelines and recommendation for the treatment of type 2 diabetes to suggest the preferential use of SGLT2is in those with evidence of heart failure and impaired kidney function, while both SGLT2i and GLP1-RAs with proven effect could be use in those with prevalent atherosclerotic cardiovascular disease. This review discusses all these elements of differentiation along with others that in the future may help establishing the best cardiorenal benefit for individuals with T2DM.

中文翻译：

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邀请审查。系列：近期CVOT对2型糖尿病的影响：哪些患者使用GLP-1RA或SGLT-2抑制剂？

大型心血管结局试验（CVOT）通过在2型糖尿病患者中使用SGLT2抑制剂（SGLT2is）和GLP1受体激动剂（GLP1-RAs）为心血管保护提供了有力支持。这两类新型降糖药已显示出对降低重大不良心血管事件（MACE：非致命性心肌梗塞，非致命性中风，心血管疾病死亡率）的风险具有相似的作用。但是，它们可能不能简单地互换。相反，仔细评估CVOT的所有结果可导致鉴定出不同的作用，这些作用可能使理想的T2DM个体概况得到描述，而他们可能会从使用一种或另一种药物中受益最多。这些差异包括对心力衰竭的影响，卒中和糖尿病肾病具有近期治疗2型糖尿病的指南和建议，提示在有心力衰竭和肾功能受损的患者中优先使用SGLT2，而经证实有效的SGLT2i和GLP1-RA可能是用于患有普遍的动脉粥样硬化性心血管疾病的人。这篇综述讨论了所有这些分化因素，以及将来可能有助于为T2DM患者建立最佳心肾益处的其他因素。