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Purpose of Review <p>This review will summarize the most contemporary trials for glucagon-like peptide 1 receptor agonists (GLP1-RA) and sodium-glucose cotransporter 2 inhibitors (SGLT2-i) and present guidance on management and recommendations on adjunctive tapering of insulin in patients with insulin-dependent diabetes mellitus, which we term “de-insulinization.”</p> Recent Findings <p>GLP1-RA and SGLT2-i are the principal classes of diabetes medications evidencing cardiovascular benefit. However, there is limited consensus on how to effectively prescribe and maintain these medications for patients on other glucose-lowering therapy, especially insulin.</p> Summary <p>Patients with type 2 diabetes and cardiovascular disease should be started on either a GLP-1RA, SGLT-i, or both in high-risk cases, while simultaneously tapering any prescribed insulin regimen. Initial selection and transition of therapy should be approached individually and systematically, with prioritization of patients with other comorbidities such as coronary artery disease, chronic kidney disease, and other diabetes complications.</p>

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GLP1-RA and SGLT2-i: Implementation and Insulin Deescalation Strategies

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年7月10日

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  • Arthi Palani,
  • Sagar Patel,
  • Shriya Patel,
  • Shivani Srivastava,
  • Jay Patel,
  • Salman Salehin,
  • Yochai Birnbaum,
  • Joseph Allencherril

摘要

Purpose of Review

This review will summarize the most contemporary trials for glucagon-like peptide 1 receptor agonists (GLP1-RA) and sodium-glucose cotransporter 2 inhibitors (SGLT2-i) and present guidance on management and recommendations on adjunctive tapering of insulin in patients with insulin-dependent diabetes mellitus, which we term “de-insulinization.”

Recent Findings

GLP1-RA and SGLT2-i are the principal classes of diabetes medications evidencing cardiovascular benefit. However, there is limited consensus on how to effectively prescribe and maintain these medications for patients on other glucose-lowering therapy, especially insulin.

Summary

Patients with type 2 diabetes and cardiovascular disease should be started on either a GLP-1RA, SGLT-i, or both in high-risk cases, while simultaneously tapering any prescribed insulin regimen. Initial selection and transition of therapy should be approached individually and systematically, with prioritization of patients with other comorbidities such as coronary artery disease, chronic kidney disease, and other diabetes complications.