A recent study published in BMC Endocrine Disorders provides insights into the anti-microvascular properties of certain antihyperglycemic drugs, highlighting new strategies for personalized therapy.

The onset and progression of diabetes-induced microvascular complications show a link with glycemic control. Some antihyperglycemic drugs, in addition to their glucose-lowering effects, can also reduce microvascular lesions. This study aimed to underscore the impact of non-insulin anti-diabetic medications on diabetic microvascular complications.

Researchers searched databases, such as Excerpta Medica (EMBASE), Web of Science, and PubMed, to select randomized controlled trials. The studies that reported microvascular complications (diabetic peripheral neuropathy (DPN), diabetic retinopathy (DR), and diabetic nephropathy (DN)) of diabetes were included in this review. The data of urinary albumin excretion rate (UAE), estimated glomerular filtration rate (eGFR), and urinary albumin to creatinine ratio (UACR) were synthesized. The microvascular effects were calculated using indices that measure cardiovascular autonomic neuropathy (CAN), vibration detection threshold (VDT), and retinal nerve fiber layer thickness (RNFLT). Additionally, the risks for DR and DPN were also integrated into the study.

The results revealed that there were only a few data points that strongly suggest Repaglinide (Repa), Sulfonylurea (SUs), α-Glucosidase inhibitors (α-GIs), or metformin are beneficial for microvascular complications when used as monotherapy.
Two trials reported that thiazolidinediones (TZDs) significantly reduced UACR, whereas another trial reported that TZDs increased VDT and improved DR, with no change in eGFR. Sodium glucose co-transporter inhibitors (SGLT-2i) showed a significant decrease in UACR. A positive effect was seen with SGLT-2i and Glucagon-like peptide-1 receptor agonists (GLP-1RA) in preventing eGFR decline.
Additionally, a recent study suggested that Dipeptidyl Peptidase IV inhibitors (DPP-IVi) might have the potential to reduce the risk of DPN. CAN and DPN did not interact with GLP-1RA. DR risk may be increased by semaglutide, which was revealed by the SUSTAIN 6 trial.