Hemodynamic effects by glucagon-like peptide-1 receptor analogues: what should be measured?
The introduction of the incretin-active antidiabetes drugs such as dipeptidyl peptidase-4 (DPP-4) inhibitors and glucagon-like peptide-1 (GLP-1) receptor antagonists/analogues (GLP-1 RA) has substantially transformed the way care is provided to patients with type 2 diabetes. These new treatment alternatives have now become documented in a number of randomized large-scale interventions trials for safety based on noninferiority versus placebo, and for some drugs also proving superiority regarding protection from cardiovascular events and mortality. Another new class of antidiabetes oral drugs, the sodium/glucose cotransporter-2 (SGLT2) inhibitors, has started to provide similar data based on trials Data from these new trials has strengthened the evidence base for medical treatment of type 2 diabetes, as also evident in current guidelines on both sides of the Atlantic [1,2]. A remaining question is to disentangle and understand the protective mechanisms involved as reduction of hyperglycemia itself, as measured by differences in hemoglobin A1c (HbA1c) levels versus placebo, is not supposed to fully explain these clinical benefits.