Fig. 1.

SGLT2 inhibitors—what do guidelines say? a The EASD and the ADA jointly published a position statement on the management of hyperglycaemia in patients with T2D that were updated to reflect evidence from CVOTs. The revised treatment pathway, which recommends an early consideration of CV risk, is also now incorporated into the ADA’s Standards of Medical Care in Diabetes, which is for the first time endorsed by the ACC. Within a CV setting, the guidelines distinguish between atherosclerotic CVD, where empagliflozin or liraglutide are preferred as 2nd line to metformin, and HF, where any SGLT2 inhibitor is preferred in this position. b The ACC has recently published its own consensus pathway for CV risk reduction in patients with T2D and CVD, advising that agents with proven CV benefit are considered concurrently to metformin, with a preference for empagliflozin or liraglutide. c A separate guideline developed by the ACC jointly with the AHA addresses the primary prevention of CVD. In patients with T2D and CV risk factors, an SGLT2 inhibitor or GLP-1 RA is recommended as an early add-on to metformin. The guideline highlights evidence from CVOTs suggesting primary prevention of HF with SGLT2 inhibitors. ACC American College of Cardiology, ADA American Diabetes Association, AHA American Heart Association, CV cardiovascular, CVD CV disease, CVOT CV outcomes trial, EASD European Association for the Study of Diabetes, GLP-1 RA glucagon-like peptide-1 receptor agonist, HF heart failure, SGLT2 sodium–glucose transporter 2, T2D type 2 diabetes