Intended for healthcare professionals


Newer drug treatments for type 2 diabetes

BMJ 2021; 373 doi: (Published 11 May 2021) Cite this as: BMJ 2021;373:n1171

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SGLT-2 inhibitors or GLP-1 receptor agonists for adults with type 2 diabetes: a clinical practice guideline

This article has a correction. Please see:

  1. Jingchuan Guo, assistant professor of pharmacy1,
  2. Steven M Smith, assistant professor of pharmacy1 2
  1. 1Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
  2. 2Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL, USA
  1. Correspondence to: S M Smith ssmith{at}

Guidance developed in partnership with patients recommends a risk based approach

Over 463 million adults worldwide live with diabetes today, and the prevalence is projected to rise to 700 million by 2045.1 Meanwhile, diabetes causes 1.5 million deaths annually—more than 60% attributable to cardiovascular disease2—and substantially increases the risk of non-fatal cardiovascular events.34 A decades-long strategy of strict glycaemic control was pursued in an effort to mitigate these risks. Yet, we now know that such glucocentric strategies have, at best, only a tenuous causal effect on reducing diabetes related cardiovascular disease and death. Fortunately, that discovery provided an opportunity to refocus efforts, both clinically and in drug development, directly on the outcomes that tend to matter most to patients.

The development of sodium-glucose cotransporter 2 (SGLT-2) inhibitors and glucagon-like peptide 1 (GLP-1) receptor agonists has created substantial opportunities for reducing death and improving cardiovascular and kidney outcomes in people with type-2 diabetes.5 Large trials have demonstrated the efficacy of these agents in reducing cardiovascular and kidney events in patients with type 2 diabetes who are at increased cardiovascular risk.67 …

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