Nieuwe en oude bloedglucoseverlagende middelen

• High glucose values are associated with vascular risk in observational studies, but glucose lowering does not automatically translate into better outcomes for patients
• In patients with type 2 diabetes and cardiovascular disease, cardiovascular benefits of GLP-1 receptor agonists and SGLT-2 inhibitors have been demonstrated.
• However, experience in clinical practice is limited and costs are high. In diabetic patients with heart failure and renal complications, SGLT-2 inhibitors may have additional beneficial effects.
• Metformin may have vascular benefits, but this has not been demonstrated for sulphonylurea derivatives, insulin and DPP-4 inhibitors
• In patients with a low cardiovascular risk, beneficial vascular effects of glucose lowering drugs have not convincingly been demonstrated.
• The outcomes of the recent studies will lead to a more personalized treatment strategy for type 2 diabetes.
• Treatment choices will depend upon patient’s risk of complications, the goal of therapy, patient preferences and costs.

Conflict of interest and financial support: potential conflicts of interest have been reported for this article. ICMJE forms provided by the authors are available online along with the full text of this article.