Clinical trials have shown that it is difficult to prevent diabetic complications, especially cardiovascular disease (CVD), when classic anti-diabetic drugs are used to control hemoglobin A1c (HbA1c) levels. Trials have also shown that while new anti-diabetic drugs are effective in significantly lowering HbA1c levels, they vary in their ability to prevent CVD complications, with dipeptidyl peptidase-4 (DPP-4) inhibitors failing to prevent CVD and the progression of renal dysfunction, while glucagon-like peptide-1 receptor agonists and sodium glucose cotransporter 2 (SGLT2) inhibitors succeed. However, SGLT2 inhibitors can cause muscle atrophy and dehydration, especially in older patients. In selecting antidiabetics, therefore, physicians should keep such potential effects in mind.
