Lowering Your Heart Disease Risk if You Have Diabetes

This article is for people who have type 2 diabetes (T2D), or anyone who wants to learn more about treatment for T2D. The goal of this patient education activity is to understand which medicines can help manage diabetes and reduce the risk for heart disease.

You will learn about:

• How diabetes increases the risk for heart disease

• Which medicines can help manage diabetes and lower the risk for heart disease risk at the same time

• How these medicines are taken and possible side effects

• Talking to your doctor about lowering your chances of heart disease

• Questions to ask your doctor

People who have diabetes also have a high risk (chance) for developing heart disease. In fact, the chances for developing heart disease are twice those seen in people who do not have diabetes.

Some common forms of heart disease include atherosclerotic disease, where you have cholesterol buildup (plaque) in the arteries of your heart that increases the risk for having a heart attack or stroke. The other type of heart disease that can develop is heart failure, where your heart becomes weak and cannot pump blood to the rest of your body very well.

There are currently 2 groups of medicines that can help manage your blood sugar and help reduce your risk for heart disease at the same time:

• GLP-1 (glucagon-like peptide-1) receptor agonists work in many parts of the body to lower and keep blood sugar at a healthy level (mostly after meals), slow down digestion, and decrease appetite. These include dulaglutide, liraglutide, and semaglutide, which are available in the form of a shot (injection)

• SGLT2 (sodium-glucose cotransporter-2) inhibitors work in the kidneys to remove extra sugar in the blood through urine. These include canagliflozin, dapagliflozin, and empagliflozin, which are available as pills

These medicines should be taken as prescribed by your doctor or healthcare team member along with practicing a heart-healthy lifestyle that includes eating healthy foods and getting regular physical activity.

There are a few GLP-1 receptor agonist shots available. They come with a small needle that goes under your skin in places like the abdomen (belly area), thigh, or upper arm.

Giving yourself a GLP-1 receptor agonist shot:

• Take a deep breath, relax, and sit or stand comfortably

• Clean the area for the shot with an alcohol swab and let it dry

• Hold the needle straight and place it under your skin

• Inject the medicine and hold the needle in place for 10 seconds

• Safely dispose of the needle

Depending on your diabetes goals, the shot can be taken either 2 times a day, once a day, or once a week. Let the medicine reach room temperature to reduce pain before the shot.

SGLT2 inhibitors come as pills and are taken once a day.

Taking an SGLT2 inhibitor pill:

• Canagliflozin should be taken before your first meal of the day

• Dapagliflozin and empagliflozin can be taken in the morning, with or without food

If you take a GLP-1 receptor agonist, you may have side effects like:

• Stomach issues such as nausea, diarrhea, vomiting, constipation, and heartburn

• Low blood sugar, if you are taking it with certain other diabetes medicines

• Pain in your abdomen

• Headache

Although they are rare, you should call your doctor or healthcare team member if you have any of the following:

• Severe pain from your abdomen to your back that does not go away

• Trouble swallowing or hoarseness in your throat

• Nausea, vomiting, fever

• Yellowing of the eyes or skin

• Blurry vision, seeing spots

• Dizziness or weakness, fast breathing, or a fast heartbeat

• Not urinating or feeling dehydrated from vomiting and diarrhea

If you take an SGLT2 inhibitor, you may have side effects that can include:

• An infection in your urinary tract or genitals

• Having to go to the bathroom more often

• Feeling thirsty

• Joint pain

• Constipation or nausea

You should call your doctor or healthcare team member if you have any of these serious side effects:

• Feeling weak, tired, thirsty, or confused

• Have fruity-scented breath

• New pain or tenderness, or sores or ulcers in your legs

• Not urinating

Based on your risk for heart disease, your current health, and your need for blood sugar control, your doctor may recommend taking a GLP-1 receptor agonist or SGLT2 inhibitor.

In addition, having a healthy lifestyle -- including a nutritious diet and regular physical activity -- and taking your medicines for any other health conditions you may have (such as high blood pressure or cholesterol) as directed can help keep your blood sugar at a healthy level and reduce your risk of heart disease.

Questions you can ask your doctor about managing your diabetes and lowering your risk for heart disease can include:

• Which medicine or medicines do you recommend for me?

• What are the potential side effects and how can we manage them?

• What else can I do to lower my risk for heart disease?

• When should I call you or get emergency help?

Congratulations!

You have successfully completed the program Lowering Your Heart Disease Risk if You Have Diabetes

View Additional Materials on this topic that you may find useful:

Patient Handout

Living With Diabetes

Manage Blood Sugar

Healthy Weight

Diabetes Medicines

Medicines for Diabetes Control