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. Sulfonylureas and many insulins may increase body weight and
may increase the risk for CVD.
5. In patients with T2DM sodium glucose transporter (SGLT) -2
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 RAs) are
indicated to treat T2DM and reduce MACE in patients with T2DM
and established CVD (liraglutide, semaglutide, and dulaglutide).
Ongoing cardiovascular outcome studies are evaluating oral
semaglutide in patients with T2DM (SOUL) and semaglutide 2.4
mg SQ per week in patients with obesity (SELECT). GLP-1 RAs
generally reduce body weight and improve other CVD risk factors
7. Metformin may decrease CVD among patients with diabetes
mellitus, and modestly reduces body weight in patients with
diabetes mellitus.
8. Anti-obesity drugs do not have CVD outcome data to support
improved CVD risk reduction; however, when accompanied by
weight loss, many anti-obesity drugs reduce blood sugar and
other CVD risk factors.
9. Liraglutide and semaglutide lowers blood sugar through weight
dependent and weight independent mechanisms.
10. Tirzepatide is a dual GLP1-glucose-dependent insulinotropic
polypeptide (GIP) agonist that was recently approved as the first
medication in this class for T2DM. In addition to HbA1c reduction,
patients experience significant weight loss on this medication.
