Impactos clínicos dos tratamentos hipoglicemiantes sobre desfechos renais e cardiovasculares no diabetes mellitus tipo 2

Abstract

Type 2 Diabetes Mellitus (T2DM) is a chronic metabolic disorder characterized by persistent hyperglycemia resulting from insulin resistance and/or impaired insulin secretion, leading to an increased risk of macrovascular and microvascular complications. Its global prevalence has risen substantially, especially in low- and middle-income countries, making it a major public health concern. The management of T2DM includes lifestyle modifications and pharmacological therapy, with different classes of antidiabetic agents that vary in their mechanisms of action and clinical impact. This narrative literature review, conducted in PubMed, Lilacs, Science and CAPES Journals databases and including studies published between 2020 and 2025, aimed to critically evaluate the effectiveness of major antidiabetic therapies on cardiovascular and renal outcomes. A total of 131 studies were initially identified, and 15 met the inclusion criteria. The findings indicate that GLP-1 receptor agonists, dual GIP/GLP-1 agonists, and SGLT2 inhibitors consistently reduce major adverse cardiovascular events, mortality, and progression of chronic kidney disease, whereas other drug classes provide benefits primarily related to glycemic control. Recent evidence highlights substantial cardiorenal benefits associated with agents such as semaglutide and tirzepatide, including reductions in MACE, decline in glomerular filtration rate, and hospitalizations for heart failure. It is concluded that therapeutic decision-making should consider not only glycemic regulation but also the patient’s cardiorenal risk profile, underscoring the importance of these modern therapies in comprehensive T2DM management.