Stephen Wiviott, MD: Changes in the Treatment of Type 2 Diabetes

Diabetes drugs like SGLT2 inhibitors—including dapagliflozin—and GLP-1 receptor agonists are changing how clinicians treat patients with diabetes and cardiovascular risks. Recent studies like the DECLARE-TIMI 58 trial of dapagliflozin showed that there are cardiovascular benefits in addition to the ability to manage diabetes.

“I think we're moving into a time where we're going to be really switching the paradigm of how we manage our patients with diabetes and cardiovascular risk,” Stephen Wiviott, MD, told MD Magazine®.

Wiviott, senior investigator of the TIMI Study Group, cardiologist at Brigham and Women’s Hospital, and Associate Professor of Medicine at Harvard Medical School, presented the study results at the American Heart Association’s Scientific Sessions 2018 in Chicago, IL. Wiviott also spoke with MD Mag about the strengths and limitations of the DECLARE trial.

Wiviott said that clinicians can expect to see more data from the DECLARE-TIMI 58 trial regarding specific subgroups, kidney disease, and biomarkers. The data may help identify which groups of patients benefit more from taking dapagliflozin.

Future research may point to other patients who could benefit—perhaps even patients without diabetes, according to Wiviott.

What further data will be released from the DECLARE-TIMI 58 trial?

[Transcript has been edited for clarity.]There’s lots of additional research being done in this area. I think it's a very exciting area presently. Certainly, we will have more information from this study, in terms of specific subgroups and other types of outcomes. There will be a lot more information about kidney disease coming forward soon. There will be information about biomarkers. We start to wonder whether we might be able to identify specific groups of patients which benefit more.

The other interesting thing is that because of the results of these types of trials over the past few years—with successful cardiovascular benefit with the SGLT2 inhibitors—there is a lot of ongoing research trying to even broaden out the population potentially further. So, patients who are being treated for heart failure, patients with chronic kidney disease, and even in some patients who don't have diabetes. The concept is whether these drugs may be beneficial independent of their effects on blood sugar. So, really a lot of exciting research going on with these classes of agents.

How are SGLT2 inhibitors like dapagliflozin changing the treatment of diabetes?

In my mind really, what's developed over the past couple of years is different than the way we've treated diabetes for decades. We used to really focus completely on blood sugar levels, what the hemoglobin a1c was, did you get it to goal, and it didn't so much matter how you got there. But with the trials of SGLT2 inhibitors and another class of drugs called GLP-1 receptor antagonists—we're now seeing that there are drugs that actually have significant [cardiovascular] benefit. So, I think we're moving away from a “how much do you lower” to “how do you lower,” using the appropriate agents that have these types of outcomes. I think we're moving into a time where we're going to be really switching the paradigm of how we manage our patients with diabetes and cardiovascular risk.