Newer Oral Antidiabetics & SGLT2 Inhibitors

Introduction

• Definition — The newer antidiabetics are the post-sulfonylurea/post-biguanide classes that exploit three previously untapped targets — the incretin axis (GLP-1 receptor agonists, the dual GIP/GLP-1 agonist tirzepatide, DPP-4 inhibitors), renal tubular glucose reabsorption (SGLT2 inhibitors), and PPARγ (glitazones).
• Paradigm shift — Their defining contribution is the move from "HbA₁c-lowering alone" to cardiorenal-outcome modification — SGLT2 inhibitors and several GLP-1 RAs reduce MACE, heart-failure hospitalisation and kidney-disease progression independently of, and beyond, glucose lowering.
• Flagship class — SGLT2 inhibitors ("gliflozins") and GLP-1 RAs are now placed early in type 2 DM for ASCVD, heart failure or CKD — chosen independently of baseline HbA₁c — and extend to HF/CKD irrespective of diabetes status.