Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Second-Line ADMs & CV Events in T2D

JAMA Netw Open; ePub 2018 Dec 21; O’Brien, et al

Among adults with type 2 diabetes (T2D) initiating second-line antidiabetic medication (ADM) therapy, the short-term cardiovascular (CV) outcomes of glucagon-like peptide-1 (GLP-1) receptor agonists, sodium-glucose cotransporter 2 (SGLT-2) inhibitors, and dipeptidyl peptidase 4 (DPP-4) inhibitors were similar, a recent study found. The cohort study included 132,737 adults (aged 45-64 years) with T2D and examined the association of second-line ADM classes with major adverse CV events. Researchers found:

  • GLP-1 receptor agonists, DPP-4 inhibitors, and SGLT-2 inhibitors were associated with similar CV outcomes.
  • Sulfonylureas and basal insulin were associated with comparatively higher CV risk.
  • Clinicians may consider prescribing newer ADM classes more routinely after metformin.


O’Brien MJ, Karam SL, Wallia A, et al. Association of second-line antidiabetic medications with cardiovascular events among insured adults with type 2 diabetes. JAMA Netw Open. 2018;1(8):e186125. doi:10.1001/jamanetworkopen.2018.6125.