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Patients with diabetes continued to exhibit a high risk for cardiovascular and renal events despite achieving
satisfactory glycemic, blood pressure and lipid targets. Studies evaluating new diabetes medications focused on
cardiovascular events, largely overlooking heart failure (HF). The latter has recently been recognised as a major cause of
morbidity and mortality in patients with diabetes mellitus. There had been an unmet need for drugs with cardiovascular
(including HF) and renal protection, with an expectation that an ideal diabetic drug should improve these end points.
Moreover, an ideal drug should have weight lowering benefits. Recently published outcome trials have shown that sodium
glucose cotransporter 2 (SGLT2) inhibitors and glucagon-like peptide 1 receptor agonists (GLP-1RAs) can reduce
cardiovascular and renal events, together with statistically significant weight reduction. As a result, many recently published
international guidelines have recommended SGLT2 inhibitors and GLP-1RAs in patients with diabetes and pre-existing
cardiovascular disease (CVD). In this review we will critically analyse the efficacy and cardiovascular (CV) safety of
SGLT2 inhibitors, based on the available literature to help position them in the clinical decision process.