4
Disease Categories
TOP 10 TAKEAWAY MESSAGES:
Obesity and Diabetes Mellitus
1. The disease of obesity may promote hyperglycemia and the
disease of type 2 diabetes mellitus (T2DM).
2. T2DM is a major risk factor for CVD. CVD is the most common cause
of morbidity and mortality among patients with obesity and T2DM.
3. Patients with obesity and T2DM optimally undergo global CVD
risk reduction (e.g., healthful nutrition and physical activity,
smoking cessation, as well as optimal control of blood glucose,
blood pressure, and blood lipids).
4. Treatment with sulfonylureas and exogenous insulins (some more
than others) may increase body weight and increase the risk for CVD.
5. In patients with T2DM, sodium glucose transporter-2 (SGLT2)
inhibitors (e.g., empagliflozin and canagliflozin) are indicated as
anti-diabetes agents that may reduce major adverse cardiovascular
events (MACE), reduce heart failure, reduce cardiovascular death
or heart failure hospitalization, reduce renal disease progression,
and in some cases, reduce overall mortality. SGLT2 inhibitors may
modestly reduce body weight and blood pressure.
6. Some glucagon-like peptide-1 receptor agonists (GLP-1 RA) are
indicated to treat T2DM and reduce MACE in patients with T2DM
and established CVD (liraglutide, semaglutide, and dulaglutide).
7. Metformin may decrease CVD among patients with diabetes
mellitus and modestly reduces body weight in patients with
diabetes mellitus.
8. Semaglutide has CVD outcome data showing a reduction in
MACE in patients with obesity and established CVD but without
diabetes. Semaglutide has also been shown to reduce heart failure
symptoms in patients with HFpEF.
9. Liraglutide and semaglutide lower blood sugar through weight-
dependent and weight-independent mechanisms.
10. Tirzepatide is a dual GLP1-glucose-dependent insulinotropic
polypeptide (GIP) agonist approved for treatment of T2DM and
obesity. In addition to HbA1c reduction, patients experience
significant weight loss on this medication.
