smWSWissmedicalweeklyReview article:Medical guidelines Published 01 April 2023 doihttps://doi.org/10.57187/smw.2023.40060Cite this as:Swiss Med Wkly.2023:153:40060Swiss recommendations of the Society forEndocrinology and Diabetes (SGED/SSED)for thetreatment of type 2 diabetes mellitus (2023)Giacomo Gastaldia,Barbara Lucchinib,Sebastien Thalmann,Stephanie Alderd,Markus Laimere,Michael Brandlef,PeterWiesli9,Roger Lehmann,Working group of the SGED/SSEDEndocrinology and Diabeles,University Hospital Geneva,Geneva,SwitzerlandEndocrinology and Diabeles,Regional Hospital Locarno,Locamo,SwitzerlandMedical Center Sihlcity,Zurich,SwitzerlandSwiss Diabetes Association,Baden,SwitzerlandEndocrinology and Diabetes,University Hospital Berne,Beme,SwitzerlandIntemal Medicine,Cantonal Hospital St.Gallen,St.Gallen,SwitzerlandIntemal Medicine and Endocrinology and Diabetes,Cantonal Hospital Frauenfeld,Frauenfeld,SwitzerlandEndocrinology,Diabetes and Clinical Nutrition,University Hospital Zrich,Zrich,SwitzerlandchairmanSummarycardiovascular outcome trial,a revolution in diabetes treat-ment took place.The initial trials with DPP.4 inhibitorsAs a first step,the authors emphasise lifestyle changesproved their cardiovascular safety,but no additional short-(increased physical activity,stopping smoking).bloodterm benefits were seen in these trials[1-4].pressure control,and lowering cholesterol).The initialmedical treatment should always be a combination treat-In 2015,the EMPA-REG trial demonstrated that em-ment with metfommin and a sodium-glucose transporter 2pagliflozin,an SGLT-2 inhibitor,was able to reduce(SGLT-2)inhibitor or a glucagon-like 1 peptide (GLP-1)re-3-point major adverse cardiovascular effects (MACE),car-ceptor agonist.Metformin is given first and up-titrated,fol-diovascular death,hospitalisation for heart failure,com-lowed by SGLT-2 inhibitors or GLP-1 receptor agonists.Inbined kidney outcome,and even mortality.The LEADERpersons with type 2 diabetes,if the initial double combina-trial with liraglutide,a GLP-1 receptor agonist,was abletion is not sufficient.a triple combination (SGLT-2 inhibitor.to achieve significant results in 3-point MACE,cardiovas-GLP-1 receptor agonist,and metformin)is recommend-cular death,combined kidney outcomes,and mortality ased.This triple combination has not been officially testedwell.These two trials were the beginning of a success sto-in cardiovascular outcome trials,but there is more andry of all SGLT-2 inhibitors and GLP-1 receptor agonists.more real-world experience in Europe and in the USA thatWhat was newly discovered by these trials was the benefitproves that the triple combination with metformin.SGLT-2of all SGLT-2 inhibitors for a reduction in hospitalisationinhibitor,and GLP-1 receptor agonist is the best treat-due to heart failure (both reduced and preserved ejectionment to reduce 3-point MACE,total mortality.and heartfraction)[5]and the reduction of stroke in all GLP-1 re-failure as compared to other combinations.The
