Type 2 diabetes is a chronic metabolic disorder affecting millions of people worldwide. It is a significant cause of morbidity and mortality due to the high risk of cardiovascular and kidney diseases. Despite intensive glucose control, the risk of these diseases remains high, prompting regulatory agencies and researchers to shift away from a glucose-centric paradigm towards prioritizing reductions in cardiovascular and chronic kidney diseases.
The two classes of drugs, SGLT-2 inhibitors, and GLP-1 receptor agonists, have shown cardiovascular and kidney benefits, particularly in patients with established cardiovascular or kidney disease. Recently, two new agents, finerenone and tirzepatide, have been introduced to treat patients with type 2 diabetes. They have shown promising results in clinical trials for improving cardiovascular outcomes and quality of life. Clinicians now face the challenge of deciding which drugs to add to ongoing therapeutic regimens for their patients with type 2 diabetes.
A new network meta-analysis published in The BMJ highlights the benefits and drawbacks of type 2 diabetic drugs such as finerenone and tirzepatide. The substantial range in baseline risks for cardiovascular and renal outcomes among persons with type 2 diabetes has a major impact on the absolute benefits of these treatments. The findings guarantee that policymakers and healthcare practitioners have quick access to information on the efficacy and safety of all types of diabetic drugs currently in use.
Therefore, the study’s findings should be regarded with care. The subject of whether finerenone may be administered safely alongside SGLT-2 inhibitors and GLP-1 receptor agonists is ignored. Because of publication bias, the authors excluded material written in languages other than English, as well as the dosage response of each medicine.
Finerenone, the first non-steroidal mineralocorticoid receptor antagonist, was found to improve renal outcomes in persons with type 2 diabetes, and overall mortality and heart failure hospitalizations were reduced. The findings only give indirect evidence for other groups, however, it is an option to SGLT-2 inhibitors and GLP-1 receptor agonists in patients with chronic renal disease.
Finerenone had a comparable effect on all-cause mortality among individuals with type 2 diabetes and varied degrees of kidney function, as determined by both the baseline estimated glomerular filtration rate and the urine albumin-creatinine ratio. Yet, fresh research suggests that finerenone may cause hyperkalemia and necessitate hospitalization in certain people. For most persons with type 2 diabetes and persistent renal impairment, hyperkalaemia provides more benefits than drawbacks. Doctors should keep an eye on potassium levels in finerenone patients, especially those who are susceptible to hyperkalemia.
Tirzepatide, the only dual GIP/GLP-1 receptor agonist presently available, had the best impact on both quality of life and weight loss when compared to other drugs and therapy groups. Individuals with type 2 diabetes who take semaglutide, the most effective GLP-1 receptor agonist, have been demonstrated to lose a significant amount of weight. Tirzepatide may be especially useful for those with type 2 diabetes who are trying to lose weight, although its effects on cardiovascular and renal outcomes are still being researched.
Overall , the study emphasizes the importance of continuous assessment of scientific progress to introduce cutting-edge updates in clinical practice guidelines for people with type 2 diabetes. These findings provide important insights into the effectiveness of different drug classes and highlight the need for personalized treatment based on the individual patient’s risk profile.