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Cited by 128Diabetes Treatment and ManagementDiabetes, Cardiovascular Risks, and LipoproteinsHeart Failure Treatment and Management

Use of Glucagon-Like Peptide-1 Receptor Agonists in Patients With Type 2 Diabetes and Cardiovascular Disease: A Review

Open access
Honigberg, Michael C., Chang, Lee-Shing, McGuire, Darren K., Plutzky, Jorge, Aroda, Vanita R., Vaduganathan, Muthiah·2020·JAMA Cardiology
DOI 10.1001/jamacardio.2020.1966PMC PMC7744318
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Abstract

Importance: Recent randomized clinical trials have demonstrated that glucagon-like peptide-1 receptor agonists (GLP-1RAs) reduce cardiovascular events in at-risk individuals with type 2 diabetes. Despite these findings, GLP-1RAs are underused in eligible patients, particularly by cardiologists. Observations: To date, randomized clinical trials of albiglutide, dulaglutide, liraglutide, and injectable semaglutide have reported favorable cardiovascular outcomes. Most recently approved for clinical use, oral semaglutide has a favorable safety profile and is currently undergoing regulatory evaluation and further study for cardiovascular outcomes. Professional society guidelines now recommend GLP-1RA therapy for cardiovascular risk mitigation in patients with type 2 diabetes and established atherosclerotic cardiovascular disease (ASCVD) or multiple ASCVD risk factors, independent of glucose control or background antihyperglycemic therapy (other diabetes medications being used). Additional conditions suitable for GLP-1RA therapy include obesity and advanced chronic kidney disease (estimated glomerular filtration rate <30 mL/min/1.73 m2), for which cardiovascular risk-reducing options are limited. Out-of-pocket costs and secondary advantages (eg, weight loss) may inform shared decision-making discussions regarding potential therapies. GLP-1RA therapy has a favorable safety profile. Its most common adverse effect is gastrointestinal upset, which typically wanes during the early weeks of therapy and may be mitigated by starting at the lowest dose and escalating as tolerated. Depending on baseline glycemic control, sulfonylureas and insulin may need to be decreased before GLP-1RA initiation; without concurrent use of insulin or sulfonylureas, GLP-1RAs are not associated with hypoglycemia. Multidisciplinary follow-up and collaborative care with primary care physicians and/or endocrinologists are important. Conclusions and Relevance: Findings from this review suggest that GLP-1RAs are safe, are well tolerated, and improve cardiovascular outcomes, largely independent of their antihyperglycemic properties, but they remain underused by cardiologists. This review provides a practical resource for cardiologists for initiating GLP-1RAs and managing the therapy in patients with type 2 diabetes and established ASCVD or high risk for ASCVD.

AI snapshot

Written from the paper’s full text.

TL;DR

GLP-1 receptor agonists are safe, well tolerated, and improve cardiovascular outcomes in patients with type 2 diabetes, largely independent of glycemic control, but remain underused by cardiologists. This review provides practical guidance for cardiologists on initiating and managing GLP-1RA therapy in patients with established ASCVD or high ASCVD risk.

Key findings

  • Across cardiovascular outcomes trials, GLP-1RAs reduced mean relative risk of MACE by 12%, cardiovascular death by 12%, all-cause mortality by 12%, stroke by 16%, myocardial infarction by 9%, and composite kidney events by 17% (driven by albuminuria improvements).
  • Uptake is low: less than 8% of individuals with type 2 diabetes and ASCVD received GLP-1RA prescriptions in 2 US observational studies, and less than 5% of GLP-1RA prescriptions in tertiary care centers were attributable to cardiologists.
  • Safety and tolerability: gastrointestinal upset occurs in 15% to 40% of patients within the first 4 weeks and is typically transient; hypoglycemia is rare without concurrent insulin or sulfonylureas; weight loss was 1.5 to 4.3 kg in trials with follow-up of 1.3 to 5.4 years.
  • Special considerations include use of liraglutide, dulaglutide, and injectable semaglutide in advanced CKD at any eGFR without dose adjustment; albiglutide reduced HF hospitalization (HR, 0.71; 95% CI, 0.53–0.94; P < .001); and injectable semaglutide was associated with retinopathy complications in SUSTAIN-6 (3.0% vs 1.8%).

Methods

  • Narrative/practical review for cardiologists; PubMed was searched for English-language studies published January 1, 2005, to October 31, 2019, identifying 7 cardiovascular outcomes trials of GLP-1RA therapy; the search was conducted August 1, 2019, to October 31, 2019.
  • Evidence was synthesized from primary trial publications, key secondary analyses, summary meta-analyses, US Food and Drug Administration labels, and professional society guidelines.
  • The review focuses on marketed GLP-1RAs with FDA indications for cardiovascular risk reduction: liraglutide, dulaglutide, and injectable semaglutide.

Limitations

  • Stated in the paper: data are limited for GLP-1RA use in end-stage kidney disease (eGFR <15 mL/min/1.73 m²), HF subtype data are lacking, head-to-head cardiovascular outcome trials between GLP-1RAs and SGLT2 inhibitors are absent, and data on incremental cardiovascular advantage of concurrent GLP-1RA plus SGLT2 inhibitor use are lacking.
  • Stated in the paper: oral semaglutide and efpeglenatide cardiovascular outcomes were still being assessed, and comparative cost-effectiveness/value studies are needed.
  • Evident from the text: this is a narrative review without systematic review or meta-analysis methods, relies on a PubMed-only English-language search through October 2019, and reports no new primary patient data.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1001/jamacardio.2020.1966

Cites

43 of 43 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 50 cited sources checked · 0 supported · 0 flagged

  • Premisecitation

    GLP-1RAs reduce MACE by a mean relative risk reduction of 12%.

    “In addition to standard of care and largely independent of hyperglycemic outcomes, the use of GLP-1RAs has demonstrated mean relative risk reduction in MACE by 12%, cardiovascular death by 12%, all-cause mortality by 12%, stroke by 16%, myocardial infarction by 9%, and composite kidney events by 17% (driven by improvements in albuminuria).4”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [4] Kristensen SL, Rorth R, Jhund PS, Cardiovascular, mortality, and kidney outcomes with GLP-1 receptor agonists in patients with type 2 diabetes: a systematic review and meta-analysis of cardiovascular outcome trials. Lancet Diabetes Endocrinol. 2019; 7(10): 776– 785. doi: 10.1016/S2213-8587(19)30249-9 31422062 source

      Not checked in the free run.

  • Interpretationcitation

    GLP-1RAs improve cardiovascular outcomes largely independent of their antihyperglycemic properties.

    “Findings from this review suggest that GLP-1RAs are safe, are well tolerated, and improve cardiovascular outcomes, largely independent of their antihyperglycemic properties, but they remain underused by cardiologists.”
    • Also stated in: § Observations · boosted
      “In addition to standard of care and largely independent of hyperglycemic outcomes, the use of GLP-1RAs has demonstrated mean relative risk reduction in MACE by 12%, cardiovascular death by 12%, all-cause mortality by 12%, stroke by 16%, myocardial infarction by 9%, and composite kidney events by 17% (driven by improvements in albuminuria).4”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [4] Kristensen SL, Rorth R, Jhund PS, Cardiovascular, mortality, and kidney outcomes with GLP-1 receptor agonists in patients with type 2 diabetes: a systematic review and meta-analysis of cardiovascular outcome trials. Lancet Diabetes Endocrinol. 2019; 7(10): 776– 785. doi: 10.1016/S2213-8587(19)30249-9 31422062 source

      Not checked in the free run.

  • Premisecitation

    GLP-1RAs reduce cardiovascular events in at-risk individuals with type 2 diabetes.

    “Recent randomized clinical trials have demonstrated that glucagon-like peptide-1 receptor agonists (GLP-1RAs) reduce cardiovascular events in at-risk individuals with type 2 diabetes.”
    • Also stated in: § Observations · boosted
      “Among commercially available GLP-1RAs, reduction in MACE has been demonstrated in randomized clinical trials of once-daily dosed liraglutide6 and 3 once-weekly injections of GLP-1RAs:semaglutide,7 albiglutide,8 and dulaglutide.9”
    • Also stated in: § CONCLUSIONS AND RELEVANCE · hedged
      “Findings from this review suggest that GLP-1RAs are safe, are well tolerated, and improve cardiovascular outcomes, largely independent of their antihyperglycemic properties, but they remain underused by cardiologists.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [6] Marso SP, Daniels GH, Brown-Frandsen K,; LEADER Steering Committee; LEADER Trial Investigators. Liraglutide and cardiovascular outcomes in type 2 diabetes. N Engl J Med. 2016; 375(4): 311– 322.doi: 10.1056/NEJMoa1603827 27295427 PMC4985288 source

      Not checked in the free run.

    • cites [7] Marso SP, Bain SC, Consoli A,; SUSTAIN-6 Investigators. Semaglutide and cardiovascular outcomes in patients with type 2 diabetes. N Engl J Med. 2016; 375(19): 1834– 1844. doi: 10.1056/NEJMoa1607141 27633186 source

      Not checked in the free run.

    • cites [9] Gerstein HC, Colhoun HM, Dagenais GR,; REWIND Investigators. Dulaglutide and cardiovascular outcomes in type 2 diabetes (REWIND): a double-blind, randomised placebo-controlled trial. Lancet. 2019; 394 (10193): 121– 130. doi: 10.1016/S0140-6736(19)31149-3 31189511 source

      Not checked in the free run.

  • Premisecitation

    GLP-1RAs reduce cardiovascular death by 12%.

    “In addition to standard of care and largely independent of hyperglycemic outcomes, the use of GLP-1RAs has demonstrated mean relative risk reduction in MACE by 12%, cardiovascular death by 12%, all-cause mortality by 12%, stroke by 16%, myocardial infarction by 9%, and composite kidney events by 17% (driven by improvements in albuminuria).4”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [4] Kristensen SL, Rorth R, Jhund PS, Cardiovascular, mortality, and kidney outcomes with GLP-1 receptor agonists in patients with type 2 diabetes: a systematic review and meta-analysis of cardiovascular outcome trials. Lancet Diabetes Endocrinol. 2019; 7(10): 776– 785. doi: 10.1016/S2213-8587(19)30249-9 31422062 source

      Not checked in the free run.

  • Premisecitation

    GLP-1RA therapy has a favorable safety profile.

    “GLP-1RA therapy has a favorable safety profile.”
    • Also stated in: § Observations · plain
      “In addition, GLP-1RAs have a favorable safety profile and have been associated with substantial weight loss.4,6,7,9”
    • Also stated in: § CONCLUSIONS AND RELEVANCE · hedged
      “Findings from this review suggest that GLP-1RAs are safe, are well tolerated, and improve cardiovascular outcomes, largely independent of their antihyperglycemic properties, but they remain underused by cardiologists.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [4] Kristensen SL, Rorth R, Jhund PS, Cardiovascular, mortality, and kidney outcomes with GLP-1 receptor agonists in patients with type 2 diabetes: a systematic review and meta-analysis of cardiovascular outcome trials. Lancet Diabetes Endocrinol. 2019; 7(10): 776– 785. doi: 10.1016/S2213-8587(19)30249-9 31422062 source

      Not checked in the free run.

    • cites [6] Marso SP, Daniels GH, Brown-Frandsen K,; LEADER Steering Committee; LEADER Trial Investigators. Liraglutide and cardiovascular outcomes in type 2 diabetes. N Engl J Med. 2016; 375(4): 311– 322.doi: 10.1056/NEJMoa1603827 27295427 PMC4985288 source

      Not checked in the free run.

    • cites [7] Marso SP, Bain SC, Consoli A,; SUSTAIN-6 Investigators. Semaglutide and cardiovascular outcomes in patients with type 2 diabetes. N Engl J Med. 2016; 375(19): 1834– 1844. doi: 10.1056/NEJMoa1607141 27633186 source

      Not checked in the free run.

    • Rests on an assumption: The most common adverse effect of GLP-1RA therapy is gastrointestinal upset, which typically wanes during the early weeks of therapy and may be mitigated by starting at the lowest dose and escalating as tolerated.
    • Rests on an assumption: Without concurrent use of insulin or sulfonylureas, GLP-1RAs are not associated with hypoglycemia.
  • May combine two claims. 11
  • Classified as probably not a substantial claim. 1

  • May combine two claims.

    Premisecitation

    GLP-1RAs reduce composite kidney events by 17%, driven by improvements in albuminuria.

    “In addition to standard of care and largely independent of hyperglycemic outcomes, the use of GLP-1RAs has demonstrated mean relative risk reduction in MACE by 12%, cardiovascular death by 12%, all-cause mortality by 12%, stroke by 16%, myocardial infarction by 9%, and composite kidney events by 17% (driven by improvements in albuminuria).4”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [4] Kristensen SL, Rorth R, Jhund PS, Cardiovascular, mortality, and kidney outcomes with GLP-1 receptor agonists in patients with type 2 diabetes: a systematic review and meta-analysis of cardiovascular outcome trials. Lancet Diabetes Endocrinol. 2019; 7(10): 776– 785. doi: 10.1016/S2213-8587(19)30249-9 31422062 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In the LEADER trial, participants with prevalent heart failure experienced consistent reduction in MACE and cardiovascular and all-cause death with liraglutide compared with participants in the non-HF subgroup and showed no excess risk of HF hospitalization.

    “Participants with prevalent HF experienced consistent reduction in MACE and cardiovascular and all-cause death with liraglutide compared with participants in the non-HF subgroup and showed no excess risk of HF hospitalization.32”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [32] Marso SP, Baeres FMM, Bain SC,; LEADER Trial Investigators. Effects of liraglutide on cardiovascular outcomes in patients with diabetes with or without heart failure. JAm Coll Cardiol. 2020; 75(10): 1128– 1141. doi: 10.1016/j.jacc.2019.12.063 32164886 source

      Not checked in the free run.

  • May combine two claims.

    Premisereasoning

    GLP-1RAs are contraindicated in patients with personal or family history of medullary thyroid cancer or multiple endocrine neoplasia syndrome type 2, although these concerns are based exclusively on observations in rodent models with uncertain human clinical relevance.

    “In general, GLP-1RAs are contraindicated in patients with personal or family history of medullary thyroid cancer or multiple endocrine neoplasia syndrome type 2 (Box), although these concerns are based exclusively on observations in rodent models with uncertain human clinical relevance, as reflected in US product labeling.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    The review conducted a PubMed search for English-language studies published between January 1, 2005, and October 31, 2019, identifying 7 cardiovascular outcomes trials of GLP-1RA therapy.

    “We searched PubMed for English-language studies published between January 1, 2005, and October 31, 2019. This search identified 7 cardiovascular outcomes trials of GLP-1RA therapy.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    GLP-1RAs are predominantly associated with decreased atherosclerosis-mediated events, whereas SGLT2 inhibitors are predominantly associated with heart failure and chronic kidney disease outcomes.

    “Specifically, GLP-1RAs are predominantly associated with decreased atherosclerosis-mediated events, whereas SGLT2 inhibitors are predominantly associated with HF and CKD outcomes.38”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [38] Garg V, Verma S, Connelly K. Mechanistic insights regarding the role of SGLT2 inhibitors and GLP1 agonist drugs on cardiovascular disease in diabetes. Prog Cardiovasc Dis. 2019; 62(4): 349– 357. doi: 10.1016/j.pcad.2019.07.005 31381891 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Increased amputation risk has not been seen with other SGLT2 inhibitors, nor with canagliflozin in the subsequent CREDENCE trial.

    “However, increased amputation risk has not been seen with other SGLT2 inhibitors, nor with canagliflozin in the subsequent CREDENCE (Canagliflozin and Renal Events in Diabetes and Nephropathy Clinical Evaluation) trial, in which such adverse events were systematically collected.40”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [40] PerkovicV Jardine MJ, Neal B,; CREDENCE Trial Investigators. Canagliflozin and renal outcomes in type 2 diabetes and nephropathy. N Engl J Med. 2019; 380(24): 2295– 2306. doi: 10.1056/NEJMoa1811744 30990260 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Two small randomized clinical trials of liraglutide in patients with heart failure with reduced ejection fraction suggested potential harm of liraglutide, although neither trial found statistically significant differences.

    “Furthermore, 2 small randomized clinical trials of liraglutide in patients with HF with reduced EF, 1 of which enrolled patients with recent HF hospitalization, suggested potential harm of liraglutide, although neither trial found statistically significant differences.36,37”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [36] Margulies KB, Hernandez AF, Redfield MM,; NHLBI Heart Failure Clinical Research Network. Effects of liraglutide on clinical stability among patients with advanced heart failure and reduced ejection fraction: a randomized clinical trial. JAMA. 2016; 316(5): 500– 508. doi: 10.1001/jama.2016.10260 27483064 PMC5021525 source

      Not checked in the free run.

    • cites [37] Jorsal A, Kistorp C, Holmager P, Effect of liraglutide, a glucagon-like peptide-1 analogue, on left ventricular function in stable chronic heart failure patients with and without diabetes (LIVE)— a multicentre, double-blind, randomised, placebo-controlled trial. Eur J Heart Fail. 2017; 19(1): 69– 77. doi: 10.1002/ejhf.657 27790809 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Metformin is a less costly, widely available alternative that has been associated with favorable cardiometabolic outcomes.

    “When both medication classes are unaffordable, metformin is a less costly, widely available alternative that has been associated with favorable cardiometabolic outcomes.42”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [42] Holman RR, Paul SK, Bethel MA, Matthews DR, Neil HA. 10-year follow-up of intensive glucose control intype2 diabetes. N Engl J Med. 2008; 359 (15): 1577– 1589. doi: 10.1056/NEJMoa0806470 18784090 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Society recommendations and guidelines support the concurrent use of GLP-1RAs and SGLT2 inhibitors when needed for adequate glycemic control, but data on whether such combinations yield incremental cardiovascular advantages are lacking.

    “Society recommendations and guidelines support the concurrent use of GLP-1RAs and SGLT2 inhibitors when needed for adequate glycemic control, but data on whether such combinations may yield incremental cardiovascular advantages are lackingthusfar.15,16,21”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [15] American Diabetes Association. 10. Cardiovascular disease and risk management: Standards of Medical Care in Diabetes-2020. Diabetes Care. 2020; 43(suppl1): S111– S134. doi: 10.2337/dc20-S010 31862753 source

      Not checked in the free run.

    • cites [16] Das SR, Everett BM, Birtcher KK, 2018 ACC expert consensus decision pathway on novel therapies for cardiovascular risk reduction in patients with type 2 diabetes and atherosclerotic cardiovascular disease: a report of the American College of Cardiology Task Force on Expert Consensus Decision Pathways. J Am Coll Cardiol. 2018; 72(24): 3200– 3223. doi: 10.1016/j.jacc.2018.09.020 30497881 PMC7560953 source

      Not checked in the free run.

    • cites [21] Cosentino F, Grant PJ, Aboyans V,; ESC Scientific Document Group. 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Eur Heart J. 2020; 41(2): 255– 323. doi: 10.1093/eurheartj/ehz486 31497854 source

      Not checked in the free run.

  • May combine two claims.

    Premisereasoning

    DPP-4 inhibitors and GLP-1RAs have overlapping mechanisms of action, so no additive efficacy is anticipated.

    “Dipeptidyl peptidase 4 inhibitors should be discontinued before initiating GLP-1RA therapy, given the lack of anticipated additive efficacy owing to overlapping mechanisms of action.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Premisenone given

    GLP-1RA initiation in individuals with poor baseline glycemic control may be a factor in worsening of diabetic retinopathy.

    “As discussed, GLP-1RA initiation in individuals with poor baseline glycemic control may be a factor in worsening of diabetic retinopathy.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    GLP-1RAs appear to be a safe, well-tolerated therapy that can improve cardiovascular outcomes, largely independent of their antihyperglycemic properties.

    “GLP-1RAs appear to be a safe, well-tolerated therapy that can improve cardiovascular outcomes, largely independent of their antihyperglycemic properties.”
    Quote in the paperSubstantial claim
12 of 12

  • The paper relies on this without support.

    The most common adverse effect of GLP-1RA therapy is gastrointestinal upset, which typically wanes during the early weeks of therapy and may be mitigated by starting at the lowest dose and escalating as tolerated.

    “Its most common adverse effect is gastrointestinal upset, which typically wanes during the early weeks of therapy and may be mitigated by starting at the lowest dose and escalating as tolerated.”

  • The paper relies on this without support.

    Without concurrent use of insulin or sulfonylureas, GLP-1RAs are not associated with hypoglycemia.

    “Depending on baseline glycemic control, sulfonylureas and insulin may need to be decreased before GLP-1RA initiation; without concurrent use of insulin or sulfonylureas, GLP-1RAs are not associated with hypoglycemia.”

  • The paper relies on this without support.

    GLP-1RAs delay gastric emptying.

    “Because GLP-1RAs delay gastric emptying, caution should be used in prescribing these agents to patients with gastroparesis, chronic nausea, or previous gastric surgical procedure.”

  • The paper relies on this without support.

    GLP-1RAs have pharmacological properties that increase heart rate.

    “Given the pharmacological properties of GLP-1RA that increase the heart rate (which may be detrimental in HF), the safety of its use in patients with HF with reduced EF remains uncertain.”

  • The paper relies on this without support.

    SGLT2 inhibitors are associated with increased risk for genital mycotic infections.

    “Because SGLT2 inhibitors are associated with increased risk for genital mycotic infections, a history of recurrent genital mycotic infections may additionally favor GLP-1RA over SGLT2 inhibitors.”
5 of 5

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Authors
Honigberg, M. C., Chang, L.-S., McGuire, D. K., Plutzky, J., Aroda, V. R., & Vaduganathan, M.
Affiliations
  • Massachusetts General Hospital (US)
  • Brigham and Women's Hospital (US)
  • The University of Texas Southwestern Medical Center (US)
ORCID
Venue
JAMA Cardiology
Publisher
American Medical Association (AMA)
Published
2020-10-01
Volume
5
Issue
10
Pages
1182
ISSN
2380-6583 (ISSN-L)
DOI
10.1001/jamacardio.2020.1966
PMC
PMC7744318
OpenAlex
W3036179581
Cited by
127
References
47
Citations by year
2026: 20 · 2025: 24 · 2024: 29 · 2023: 18 · 2022: 18 · 2021: 16 · 2020: 2
FWCI
2.07
Type
journal article
Language
en
Open access
Locations
  • JAMA Cardiology (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Heart, Lung, and Blood Institute (T32HL094301)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
Keywords
GLP-1 receptor agonists, type 2 diabetes, atherosclerotic cardiovascular disease, cardiovascular risk reduction, semaglutide, albiglutide, dulaglutide, liraglutide, obesity, chronic kidney disease, gastrointestinal adverse effects, hypoglycemia, sulfonylureas, insulin, multidisciplinary care, shared decision-making
MeSH terms
Glucagon-Like Peptide-1 Receptor, Contraindications, Drug, Sodium-Glucose Transporter 2 Inhibitors, Glucagon-Like Peptide-1 Receptor Agonists, Cardiovascular Diseases, Diabetes Mellitus, Type 2, Heart Failure, Humans, Hypoglycemic Agents, Obesity, Overweight, Renal Insufficiency, Chronic

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