Evidence mapPaperPMID 41489681Full record

ReviewDiabetes therapy : research, treatment and education of diabetes and related disorders2026

Rewriting Diabetes Therapy: How Incretin Modulation is Transforming Cardiovascular and Renal Outcomes.

José Pablo Miramontes-González, Álvaro Rodrigo-Alaíz, Miriam Gabella-Martín, David González-Calle, Juana Carretero-Gómez, Luis Corral-Gudino

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Review in Diabetes therapy : research, treatment and education of diabetes and related disorders, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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4 · The record

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5 · Who and what money

Authors and funding

6 authors.

José Pablo Miramontes-GonzálezSchool of Medicine, Valladolid University, Av. Ramón y Cajal, 7, 47003, Valladolid, Spain. jpmiramontes@uva.es.ORCID http://orcid.org/0000-0002-2247-9679
Álvaro Rodrigo-AlaízSchool of Medicine, Valladolid University, Av. Ramón y Cajal, 7, 47003, Valladolid, Spain.
Miriam Gabella-MartínInternal Medicine Unit, Río Hortega University Hospital, Valladolid, Spain.
David González-CalleCardiology Unit, Salamanca University Hospital, Salamanca, Spain.
Juana Carretero-GómezInternal Medicine Unit, Hospital Badajoz, Badajoz, Spain.
Luis Corral-GudinoSchool of Medicine, Valladolid University, Av. Ramón y Cajal, 7, 47003, Valladolid, Spain.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionIn patients with type 2 diabetes mellitus (T2DM), cardiovascular (CV) disease and chronic kidney disease (CKD) drive excess morbidity and mortality. Beyond glucose-lowering, incretin-based therapies may provide organ protection across the cardiorenal axis.

methodsNarrative review of mechanistic pathways and randomized trials of GLP-1 receptor agonists (GLP-1RA), DPP-4 inhibitors, and newer dual/triple agonists, with targeted updates from recent pivotal programs (SELECT, FLOW, SOUL, SURPASS-CVOT) and emerging oral small-molecule GLP-1R agonists.

resultsLong-acting GLP-1RA reduces major adverse CV events (MACE), all-cause and CV death, heart-failure hospitalization, and kidney composites across CV outcome trials and meta-analyses. A 2019 pooled analysis and a 2025 update confirm consistent reductions in MACE and hard kidney outcomes independent of baseline HbA1c. In obesity without diabetes, semaglutide 2.4 mg lowered MACE in SELECT, expanding prevention beyond glycemia. In CKD with T2DM, FLOW showed that semaglutide reduced major kidney disease events and death from CV/kidney causes. In T2DM with ASCVD and/or CKD, the SOUL cardiovascular outcome trial (CVOT) demonstrated that oral semaglutide reduced three-point MACE versus placebo. In head-to-head CVOT, tirzepatide was non-inferior to dulaglutide on MACE while achieving greater weight and HbA1c reductions. Mechanistically, GLP-1R signaling spans Gs-cAMP/PKA, β-arrestin-dependent pathways, and additional routes (including Gq contexts), aligning with anti-inflammatory, natriuretic, and antifibrotic effects observed preclinically and clinically. Oral non-peptide GLP-1R agonists (e.g., orforglipron) show phase 2 efficacy but lack long-term CV/renal outcome data.

conclusionsIncretin-based therapy has shifted care from glucose-centric targets to cardiorenal risk reduction. GLP-1RA are guideline-endorsed for patients with T2DM and high CV/renal risk irrespective of HbA1c; dual agonists and oral small-molecule agents may broaden indications pending definitive outcome evidence.

Indexed as

Cardiovascular outcomesChronic kidney diseaseDual agonistGLP-1 receptor agonistIncretinRenal protectionTirzepatideType 2 diabetes

Identifiers

PMID41489681
PMCPMC13000015

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.