Which medication would risk more adverse CV outcomes for a patient with diabetes?

Saxagliptin is associated with a potential increase in cardiovascular risk, particularly in patients with type 2 diabetes. Research has indicated that certain DPP-4 inhibitors, such as saxagliptin, may be linked to a higher incidence of heart failure hospitalization compared to other diabetes medications. This concern stems from findings in clinical trials where saxagliptin did not demonstrate cardiovascular benefit and raised the possibility of adverse cardiovascular outcomes.

In contrast, other options have demonstrated either neutral effects or beneficial effects on cardiovascular outcomes. For example, glipizide and repaglinide, both being sulfonylureas or meglitinides, typically do not increase cardiovascular risk, although they may not provide the protective benefits seen with some other classes. Meanwhile, empagliflozin, an SGLT2 inhibitor, has shown cardiovascular benefits, including reductions in the risk of cardiovascular events and heart failure in patients with diabetes.

Understanding the cardiovascular safety profiles of these medications is crucial for managing patients with diabetes, particularly those at high risk for cardiovascular complications.