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CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 2, March 2013
46
AFRICA
Achieving glycaemic control
Incretins: cardiovascular safety and
rationale for use
T
he majority of type 2 diabetes
patients die from cardiovascular
events with MI and stroke being
responsible for 75% of the increased
mortality seen in diabetic patients. ‘One
of the most important interpretations
of the UKPDS trial
4
of newly diagnosed
patients and that of the STENO II trial
5
of recently diagnosed type 2 diabetes
patients is that the earlier you can treat
the patient, the better the outcome,
and then you can achieve a reduction
in MI events over time’, Dr Adri Kok,
Johannesburg physician noted.
‘The failure of our current diabetes
treatment is that we do not achieve
adequate glycaemic control. The
incretins, with their weight-loss or
weight-neutral effects are able to add
to our HbA
1c
-lowering efficiency without
causing hypoglycaemia or further side
effects in patients who are already taking
multiple therapies’, she said.
Giving a snapshot view of the GLP-1
agonist injectables, exenatide and liraglu-
tide, followed by the oral DPP-4s (vilda-
gliptin, sitagliptin and saxagliptin), Dr
Kok noted that their usefulness has been
shown in a wide range of type 2 diabetes
patients on both oral and insulin therapy.
‘While we do not yet have clinical trials
designed to show effects on cardiovascular
outcomes, there have been studies on all
the incretins that indicate a cardiovascular
risk reduction’,
6
Dr Kok said. This finding
has led to a study-generating hypothesis
which is currently being evaluated in the
SAVOR-TIMI53 trial (Saxagliptin Assess-
ment of Vascular Outcomes Recorded in
patients with diabetes-thrombolysis in
Myocardial Infarction).
Dr Kok noted that the 2012 SEMDSA
guidelines for type 2 diabetes management
support the early use of the oral DPP-4
inhibitors in combination with metformin.
‘It is important to discuss with your
diabetic patients their cardiovascular risk,
explaining the important benefits and
advantages of these incretin-based thera-
pies as alternative to other agents such as
the sulphonylurea and thiazolidinedione
groups of drugs. The total cardiovascular
risk of the patient with type 2 diabetes
must be addressed with strict glucose
control early in the course of the disease
to avoid micro- and macrovascular com-
plications later on’, Dr Kok concluded.
Dr Adri Kok
The failure of our current diabetes
treatment is that we do not achieve
adequate glycaemic control
“
”
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