Stefano del Prato

Pisa, Italy

Stefano Del Prato is Professor of Endocrinology and Metabolism at the School of Medicine, University of Pisa and Chief of the Section of Diabetes, University Hospital of Pisa, Italy. He graduated from the University of Padova, Italy and undertook postgraduate specialisation in Endocrinology and Internal Medicine. Professor Del Prato’s main research interests focus on the physiopathology and therapy of type 2 diabetes and insulin resistance. He is a member of many societies and associations including the European Association for the Study of Diabetes (EASD) and the American Diabetes Association. Professor Del Prato is past Vice-President of the EASD, past President and Honorary President of the Italian Society of Diabetology, and the current Chairman of the European Foundation for the Study of Diabetes (EFSD). Professor Del Prato is the recipient of many awards including the Prize of the Italian Society of Diabetology for outstanding scientific activity and the Honorary Professorship at the Universidad Peruana Cayetano Heredya in Lima.

Tuesday 02 June 09:30

Prevention of cardiovascular diseases by glucose lowering drugs

Individuals with type 2 diabetes are at greater risk for cardiovascular disease and associated mortality than those without diabetes. Previous clinical studies had consistently showed that improving glycaemic control in patients with type 2 diabetes had minimal effect, or at best, only a modest effect in reducing the risk of cardiovascular events. However, the growing armamentarium of glucose-lowering therapies has yielded new insights. Clinical trials with the glucagon-like peptide 1 (GLP-1) receptor agonists and sodium-glucose cotransporter-2 (SGLT2) inhibitors have shown a favourable benefit-risk balance in mitigating cardiovascular risk in high-risk patients with type 2 diabetes. Both empagliflozin and liraglutide also showed reduction in all-cause mortality in diabetic patients with cardiovascular disease. These benefits were independent of the glucose-lowering effects of these agents and improvement in traditional cardiovascular risk factors. European guidelines on diabetes, pre-diabetes and cardiovascular disease now recommend GLP‑1 receptor agonists and SGLT2 inhibitors as first-line treatments in type 2 diabetes patients with established cardiovascular disease or at high/very high risk of cardiovascular disease.

These recommendations herald a new paradigm for the management of patients with type 2 diabetes to improve cardiovascular outcome. With the increasing prevalence of obesity and diabetes globally, the advent of pharmacotherapies with proven efficacy in reducing cardiovascular outcomes makes it imperative to understand the underlying mechanisms for these cardiovascular benefits, to inform clinicians for the best approach for combination glucose-lowering therapy in patients with type 2 diabetes.

Key references

Del Prato S. Heterogeneity of diabetes: heralding the era of precision medicine. Lancet Diabetes Endocrinol 2019;7:659-66.

Del Prato S. Rational combination therapy for type 2 diabetes. Lancet Diabetes Endocrinol 2019;7:328-9.

Hernandez AF, Green JB, Janmohamed S, D’Agostino RB Sr, Granger CB, Jones NP, Leiter LA, Rosenberg AE, Sigmon KN, Somerville MC, Thorpe KM, McMurray JJV, Del Prato S; Harmony Outcomes committees and investigators. Albiglutide and cardiovascular outcomes in patients with type 2 diabetes and cardiovascular disease (Harmony Outcomes): a double-blind, randomised placebo-controlled trial. Lancet 2018;392:1519-29.