What are the benefits of SGLT-2 inhibitors and GLP-1R agonists in adults with T2DM and additional risk factors for CVD?
SGLT-2 inhibitors act in the proximal tubule to increase urinary excretion of glucose and sodium, leading to a reduction in HbA1c, body weight, and BP. Three RCTs have shown a significant reduction in ASCVD events and heart failure with use of an SGLT-2 inhibitor.  GLP-1R agonists increase insulin and glucagon production in the liver, increase glucose uptake in muscle and adipose tissue, and decrease hepatic glucose production. Three GLP-1R agonists have been found to significantly reduce the risk of ASCVD in adults with T2DM who are at high risk. Therefore, it may be reasonable to initiate these 2 classes of medications for primary prevention of CVD in patients with T2DM and additional risk factors for CVD. 