Investor Presentation Full Year 2021
35
Investor presentation
Full year 2021
Novo NordiskⓇ
Class
HbA1c
change
Hypoglycaemia Weight
risk
change
CV risk
reduction
Metformin
1.5
No
Neutral
Minimal
GLP-1s have positive effects beyond glycaemic control and
treatment guidelines now reflect the CV risk benefits.
Medications for treatment of type 2 diabetes
ADA/EASD diabetes treatment guidelines for second-line
treatment with established ASCVC or CKD
First-line therapy is metformin and lifestyle management.
If HbA₁ above target, proceed as below
NO
Without
established
ASCVD or CKD
Established ASCVD or CKD
Sulfonylurea
1.5
Yes
Gain
None
YES
ASCVD predominates
TZDS
0.5-1.4
No
Gain
Varies
HF OR CKD
predominant
DPP-IV inhibitors
0.6-0.8
No
Neutral
Neutral
GLP-1
with proven CVD
benefit*
SGLT-2 inhibitors
0.5 -0.9
No
Loss
Varies
EITHER/OR
SGLT-2
with proven CVD
benefit*,
if eGFR adequate
GLP-1
1.0-1.8
No
Loss
Varies
Long-acting insulin
1.5-2.5
Yes
Gain
TG and HDL
Fast-acting insulin
1.5-2.5
Yes
Gain
TG and HDL
If HbA1c above target
If further intensification is required or patient is now unable to
tolerate GLP-1 and/or SGLT-2, choose agents demonstrating CV safety
*Proven CVD benefit means it has label indication of reducing CVD events. For GLP-1 strongest evidence for
liraglutide>semaglutide>exenatide extended release. For SGLT-2 evidence modestly stronger for empagliflozin>canagliflozin.
ASCVD: atherosclerotic cardiovascular disease; CKD: chronic kidney disease; CV: cardiovascular; CVD: cardiovascular disease;
CVOT: cardiovascular outcome trial; DPP-4: dipeptidyl peptidase-4 inhibitor; eGFR: estimated glomerular filtration rate; GLP-1:
glucagon-like peptide-1 receptor agonist; HF: heart failure; SGLT-2: sodium glucose co-transporter-2 inhibitor
Sources: Adapted from: Nathan DM, et al. Diabetes Care. 2006; 29: 1963-1972; Nathan DM, et al. 2007;30:753-
759; Nathan DM, et al. Diabetes Care. 2008;31:173-175. ADA. Diabetes Care. 2008; 31:S12-S54. WelChol PI.
1/2008. Management of Hyperglycemia in Type 2 Diabetes, 2018. A Consensus Report by the American Diabetes
Association (ADA) and the European Association for the Study of Diabetes (EASD)View entire presentation