Often in the world of medicine, progress is made in unexpected ways. Researchers sometimes find solutions to problems not by carefully planned experiments but by happy accidents. A prime example of this is in recent advancements in treating heart and kidney disease with new families of medications initially intended to treat type 2 diabetes (T2D). 
For nearly thirty years, the drug Metformin was widely prescribed as a reliable treatment for people with T2D. It was a tool in the medicine bag used for decades because it was effective, safe, and affordable. It focuses primarily on controlling glucose, or sugar, in the blood. Now, it looks like it’s time to retire it from its pedestal for Metfomin to make some room for its rivals because the newer drugs that are coming out handle blood sugar levels as well as Metformin can, but can also go on to produce significant benefits in other vital areas of health.
New treatments for type 2 diabetes
Medicine continues to evolve and grow. New medications such as Ozempic and Mounjaro have emerged in the past five years. These were developed for the same purpose as Metformin, to control glucose and to do this more effectively. But they were found to do much more.
These drugs, called GLP-1 receptor agonists, represented a vital leap forward in treating diabetes and its complications by controlling glucose levels. But now, they also play a crucial role in protecting vital organs because of their improved glucose-lowering effects and other features that work independently.
Expanding into weight loss
This happenstance came about because the focus of the drugs, initially, was on the single subject of diabetes. Then, unpredictably but happily, people using the medication were showing extra benefits that added depth and new dimensions to the power of the drugs.
After Ozempic (a GLP-1 receptor agonist called semaglutide) was approved for treating T2D in 2017 and was becoming widely used, reports came in that people using the drug were also losing significant weight and waistline. For most of them, this was a big plus because often diabetes and obesity go hand-in-hand. For these people, loss of weight was a big bonus.
One of the consequences of these developments was that Ozempic became wildly popular as a weight-reducing treatment – so much so that there was a worldwide shortage of supply for traditional users suffering from T2D and the new customers looking to shed some weight and inches.
Alongside Ozempic, several other drugs based on similar chemicals to semaglutide reached the market. In particular, Mounjaro (tirzepatide combining GLP-1 with glucose-dependent insulinotropic polypeptide – GIP) has proven to deliver similar results. These effective treatments for T2D showed powerful side benefits of weight loss.
Extra benefits in heart and kidney health
Next, further investigation showed that these kinds of drugs have other unrelated benefits, especially in reducing conditions that can develop into serious heart and kidney disease. People with conditions related to the heart and blood vessels, like hypertension (high blood pressure), atherosclerotic cardiovascular disease (CVD), heart failure (HF), or chronic kidney disease (CKD), have experienced notable improvements with the new medicines. This shift in understanding and treatment came about through extensive research, including cardiovascular outcome trials (CVOTs) and heart and kidney disease studies.
The FDA now suggests that doctors change their perspective on treating diabetes. Rather than focusing only on glucose control, as they’ve been doing for years, they should adopt a “holistic management approach.” This means looking at the whole picture and emphasizing the protection of the whole body.
This new perspective is based on reviewing numerous clinical trials and analyses identifying specific advantages of these newer medications over Metformin. They have shown significant benefits in reducing heart-related issues, progressive kidney disease, and eye complications in diabetic patients. That’s what these new medicines are good at. They don’t just control glucose; they also help with weight loss and protect vital organs like the heart and kidneys.
In conclusion, the discovery of the benefits of these new medications exemplifies how progress in medicine is sometimes made by accident. It highlights the importance of being open to new development and the continuous evolution of medicine. Just like in many areas of life, sometimes the most profound discoveries are made when we least expect them, leading to more comprehensive and practical solutions to people’s problems.
FAQ
Which diabetes medications improve cardiovascular outcomes?
Approved drugs in the GLP-1 receptor agonists and SGLT2i classes have demonstrated consistent and significant benefits in improving cardiovascular outcomes – including heart attack, stroke, heart failure, and cardiovascular death.
Does semaglutide have cardiovascular benefits?
As reported in the PIONEER 6 trials, semaglutide delivers cardiovascular benefits and reduces the incidence of mortality by about half. It was also reported that patients taking Ozempic had a significantly lower risk of major adverse cardiovascular events (MACE) such as cardiovascular death, non-fatal heart attack or non-fatal stroke. The SUSTAIN 6 trial also showed that semaglutide manages diabetes with minimal cardiovascular side effects.
Does Ozempic help with Chronic Kidney Disease?
Patients with type 2 diabetes and CKD are at high risk for cardiovascular disease and kidney failure. Studies have found that significant beneficial effects on kidney function and renal outcomes were seen with treatment by Ozempic. Fewer people showed a persistent drop in estimated glomerular filtration rate (eGFR), which is a test that measures levels of kidney function and determines the stage of kidney disease. People with pre-existing kidney disease achieved a significantly slower annual loss of kidney function compared to those receiving a placebo.
Which GLP-1 drugs have cardiovascular benefits?
Several GLP-1 RA drugs, including Ozempic, have been approved by the FDA in the U.S. for the treatment of patients with type 2 diabetes who are at high risk for atherosclerosis. Such GLP-1 RAs have also been shown to reduce the risk of cardiovascular disease in patients regardless of needing better blood glucose control.
What are the benefits of GLP-1 agonists with CKD?
Some of the preferred glucose-lowering agents for patients with type 2 diabetes and CKD are long-acting glucagon-like peptide-receptor agonists (GLP1RA) because of their actions in reducing atherosclerotic cardiovascular events, reducing albuminuria and slowing eGFR decline.
2 Responses
Where does Farxiga fit in this area?
Thank you for this interesting query. Indeed, Farxiga and other SGLT2 inhibitors have been found to have positive results in slowing the progression of kidney disease. The DAPA‐CKD (Dapagliflozin and Prevention of Adverse Outcomes in Chronic Kidney Disease) trial showed that dapagliflozin reduced the risk of major kidney and cardiovascular events and prolonged survival in patients with chronic kidney disease (CKD), with and without type 2 diabetes. We will be writing another blog in the near future concentrating on the relevance of SGLT2 inhibitors like Farxiga for both kidney and heart disease.