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REWIND randomized nearly 10,000 people with type 2 diabetes to weekly dulaglutide or placebo and followed them for a median of more than five years. Dulaglutide significantly reduced the composite of nonfatal myocardial infarction, nonfatal stroke or cardiovascular death. Importantly, a substantial proportion of participants did not have established cardiovascular disease at baseline, making the results relevant to primary prevention as well as secondary prevention. For internists, REWIND supports selecting glucose-lowering therapy with attention to cardiovascular risk even when HbA1c is not markedly elevated. As with other GLP-1 receptor agonists, gastrointestinal adverse effects and the need for sustained treatment should be discussed. The trial also demonstrates that cardiovascular outcomes are not limited to patients with advanced diabetes. Risk assessment should therefore begin early, with treatment decisions informed by obesity, blood pressure, kidney disease, lipid status and cardiovascular history rather than glycemic numbers alone.
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REWIND randomized nearly 10,000 people with type 2 diabetes to weekly dulaglutide or placebo and followed them for a median of more than five years. Dulaglutide significantly reduced the composite of nonfatal myocardial infarction, nonfatal stroke or cardiovascular death. Importantly, a substantial proportion of participants did not have established cardiovascular disease at baseline, making the results relevant to primary prevention as well as secondary prevention. For internists, REWIND supports selecting glucose-lowering therapy with attention to cardiovascular risk even when HbA1c is not markedly elevated. As with other GLP-1 receptor agonists, gastrointestinal adverse effects and the need for sustained treatment should be discussed. The trial also demonstrates that cardiovascular outcomes are not limited to patients with advanced diabetes. Risk assessment should therefore begin early, with treatment decisions informed by obesity, blood pressure, kidney disease, lipid status and cardiovascular history rather than glycemic numbers alone.
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