PURPOSE OF REVIEW: The purpose is to review evidence on cardiovascular risks and 
benefits of new treatments for type 2 diabetes mellitus.
RECENT FINDINGS: In response to guidance issued by the Food and Drug 
Administration, thousands of patients have been enrolled in large randomized 
trials evaluating the cardiovascular effects of the three newest diabetes drug 
classes: glucagon-like peptide-1 (GLP-1) receptor agonists, sodium glucose 
cotransporter 2 (SGLT-2) inhibitors, and dipeptidyl peptidase-4 (DPP-4) 
inhibitors. Two studies of GLP-1 receptor agonists-one of liraglutide and one of 
semaglutide-have shown cardiovascular benefit relative to placebo, and one study 
of the SGLT-2 inhibitor empagliflozin has shown benefit. The other published 
cardiovascular outcome studies of the newest drug classes have generally 
supported safety, apart from an as-yet unresolved safety concern about increased 
rates of heart failure with DPP-4 inhibitors. Recent research suggests the 
thiazolidinedione pioglitazone may have beneficial effects on some 
cardiovascular outcomes as well, but these are counterbalanced by a known 
increase of the risk of heart failure with this drug. In general, more 
prospective randomized trial data is now available regarding the cardiovascular 
effects of the newer diabetes drugs than on the older drug classes. New evidence 
suggests that the newest diabetes drugs are safe from a cardiovascular 
perspective. Evidence on benefit from at least some members of the GLP-1 
receptor agonist and SGLT-2 inhibitor classes is encouraging but not yet 
decisive.