Language
English
Publication Date
4-1-2026
Journal
Cardiovascular Drugs and Therapy
DOI
10.1007/s10557-025-07744-8
PMID
40637950
PMCID
PMC12992454
PubMedCentral® Posted Date
7-10-2025
PubMedCentral® Full Text Version
Post-print
Abstract
Purpose of review: This review will summarize the most contemporary trials for glucagon-like peptide 1 receptor agonists (GLP1-RA) and sodium-glucose cotransporter 2 inhibitors (SGLT2-i) and present guidance on management and recommendations on adjunctive tapering of insulin in patients with insulin-dependent diabetes mellitus, which we term "de-insulinization."
Recent findings: GLP1-RA and SGLT2-i are the principal classes of diabetes medications evidencing cardiovascular benefit. However, there is limited consensus on how to effectively prescribe and maintain these medications for patients on other glucose-lowering therapy, especially insulin. Patients with type 2 diabetes and cardiovascular disease should be started on either a GLP-1RA, SGLT-i, or both in high-risk cases, while simultaneously tapering any prescribed insulin regimen. Initial selection and transition of therapy should be approached individually and systematically, with prioritization of patients with other comorbidities such as coronary artery disease, chronic kidney disease, and other diabetes complications.
Keywords
Humans, Sodium-Glucose Transporter 2 Inhibitors, Diabetes Mellitus, Type 2, Glucagon-Like Peptide-1 Receptor Agonists, Insulin, Hypoglycemic Agents, Blood Glucose, Cardiovascular Diseases, Incretins, Treatment Outcome, Diabetes, Cardiovascular disease, SGLT2-i, GLP-1RA, Heart failure, Outcomes, Insulin de-escalation
Published Open-Access
yes
Recommended Citation
Palani, Arthi; Patel, Sagar; Patel, Shriya; et al., "GLP1-RA and SGLT2-i: Implementation and Insulin Deescalation Strategies" (2026). Faculty, Staff and Students Publications. 6827.
https://digitalcommons.library.tmc.edu/baylor_docs/6827