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Three decades of glucose-lowering therapy in patients at high cardiovascular risk - A real-world analysis
Journal article   Peer reviewed

Three decades of glucose-lowering therapy in patients at high cardiovascular risk - A real-world analysis

Magdalena Neyer, Johannes B Vogel, Pascal Elsner, Heike Kuehrer, Christoph H Saely, Axel Muendlein, Alexander Vonbank, Arthur Mader, Andreas Festa, Heinz Drexel, …
Diabetes, obesity & metabolism, v 27(2), pp 835-844
Feb 2025
PMID: 39604296

Abstract

Aged Blood Glucose - drug effects Blood Glucose - metabolism Cardiovascular Diseases - epidemiology Cardiovascular Diseases - etiology Cardiovascular Diseases - prevention & control Coronary Angiography Diabetes Mellitus, Type 2 - blood Diabetes Mellitus, Type 2 - complications Diabetes Mellitus, Type 2 - drug therapy Diabetic Angiopathies - epidemiology Diabetic Angiopathies - prevention & control Drug Therapy, Combination Europe - epidemiology Female Glycated Hemoglobin - analysis Heart Disease Risk Factors Humans Hypoglycemic Agents - therapeutic use Male Middle Aged Sodium-Glucose Transporter 2 Inhibitors - therapeutic use
Over recent years, therapy options and strategies for type 2 diabetes mellitus (T2DM) have developed substantially. This study investigated glucose-lowering treatment in patients with high cardiovascular risk over three decades. A total of 2158 patients undergoing elective coronary angiography at a tertiary care hospital in Europe were included in three sequential observational studies (OS): OS1 (1999-2000; n = 672), OS2 (2005-2008; n = 1005) and OS3 (2022-2023; n = 481). Sociodemographic data, patient-reported medication, medical histories and blood samples were analysed. A clear trend towards more complex glucose-lowering therapies was found. A wider array of glucose-lowering drugs was used over time (OS1: 11; OS2: 21; OS3: 25) and the number of different drugs used in combination therapy in a single patient increased to a maximum of five in OS3. Furthermore, substantial differences in applied medication regimens were observed: Sodium-glucose cotransporter-2 inhibitors were the most frequently reported substance class (34.0% of total reported glucose-lowering drugs) in OS3, whilst metformin remained a key component (OS1: 33.9%; OS2: 41.8%; OS3: 32.0%). Other drug classes like sulfonylureas were largely replaced. A total of 69.2% of patients in OS3 achieved an HbA1c level of < 7% (vs. OS1: 51.9%, OS2: 54.7%; p < 0.001). Over 25% of patients with T2DM were newly diagnosed at admission (OS1: 43.8%, OS2: 29.7%, OS3: 27.2%; p  < 0.001) and had therefore no diabetes-related medication. These real-world data emphasize a marked shift in T2DM treatment towards novel substance classes. However, the use of incretin mimetics remained low. Significantly more patients reached HbA1c targets in the most recent cohort.

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Collaboration types
International collaboration
Web of Science research areas
Endocrinology & Metabolism
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