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SUSTAIN-6 evaluated once-weekly semaglutide in people with type 2 diabetes at high cardiovascular risk. The trial showed a significant reduction in the first occurrence of the composite of cardiovascular death, nonfatal myocardial infarction or nonfatal stroke versus placebo. The results helped move GLP-1 receptor agonists toward an organ-protective role in diabetes care, particularly for patients with established or high cardiovascular risk. For internists, the practical implication is that drug selection should be based on more than HbA1c efficacy. Weight, cardiovascular risk, kidney disease, treatment burden and adverse-effect profile should all be incorporated into shared decisions. The trial was not designed to establish every mechanism behind the benefit, and its population had substantial cardiovascular risk, so extrapolation to very low-risk patients should be cautious. Nevertheless, the findings support a broader model of type 2 diabetes management in which glucose lowering and cardiovascular risk reduction are considered together. It also highlights why early identification of high-risk patients can change the therapeutic pathway even when their HbA1c is not dramatically elevated.
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SUSTAIN-6 evaluated once-weekly semaglutide in people with type 2 diabetes at high cardiovascular risk. The trial showed a significant reduction in the first occurrence of the composite of cardiovascular death, nonfatal myocardial infarction or nonfatal stroke versus placebo. The results helped move GLP-1 receptor agonists toward an organ-protective role in diabetes care, particularly for patients with established or high cardiovascular risk. For internists, the practical implication is that drug selection should be based on more than HbA1c efficacy. Weight, cardiovascular risk, kidney disease, treatment burden and adverse-effect profile should all be incorporated into shared decisions. The trial was not designed to establish every mechanism behind the benefit, and its population had substantial cardiovascular risk, so extrapolation to very low-risk patients should be cautious. Nevertheless, the findings support a broader model of type 2 diabetes management in which glucose lowering and cardiovascular risk reduction are considered together. It also highlights why early identification of high-risk patients can change the therapeutic pathway even when their HbA1c is not dramatically elevated.
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