Pharmacological Management Evolution of Type 2 Diabetes Mellitus: Focus on Cardiovascular Outcomes Trials from 2013 to 2020 and Their Impact on Practice Guidelines

In this brief review of the recent evolution of the pharmacological treatment of Type 2 Diabetes Mellitus (T2DM), we will analyze how different ways of living with diabetes coexist around the world. To define them, we will use the concept that we have called the three contemporary visions of T2DM, namely: dark vision, luminous vision, and bright vision. We will also discuss how the glucocentric paradigm of T2DM treatment led to the development, implementation, and publication of the Cardiovascular Outcomes Trials (CVOTs) in T2DM. Since June 2013, eighteen CVOTs have been published that have studied the cardiovascular safety of fifteen anti-diabetic drugs belonging to four new therapeutic classes. Together, these studies have included more than 150,000 individuals with a cumulative average follow-up of almost half a million patient-years. These studies have shown that beyond glycemic control, six drugs-Empagliflozin, Canagliflozin, Dapagliflozin, Liraglutide, Semaglutide, and Dulaglutide belonging to two new therapeutic classes, significantly reduce the cerebrovascular, cardiovascular, and renal morbidity and mortality of T2DM patients. Thus, establishing a new paradigm in the pharmacological treatment of T2DM, the paradigm of cerebral and cardio-renal protection of the diabetic individual. This substantial evidence has been transferred to the T2DM practice guidelines and, for the first time in this medical field, has been homologated around the world.