The American Diabetes Association (ADA) recommends sodium glucose co-transporter inhibitors (SGLT2 inhibitors) and incretin-based drugs for people with type 2 diabetes who have existing or high risk for cardiovascular and kidney diseases.1,2 In some cases, doctors may use them together with other medications for added protection. Additionally, incretin-based drugs are useful for those seeking weight loss. Large studies show these medications lower rates of heart attack, stroke, heart-related death, and heart-failure hospitalizations, and they provide better kidney protection than older diabetes medications.3,4,5,6,7
Dapagliflozin and empagliflozin are examples of SGLT2 inhibitors with multiple beneficial effects to delay the above-mentioned chronic conditions. These are oral medications and administered once daily. Semaglutide and tirzepatide are examples of incretin-based medications. These are injectable medications which are administered once weekly.8
Regulatory agencies and medical societies, including the Food and Drug Administration (FDA), American Heart Association (AHA), American College of Cardiology (ACC), and ADA have approved specific SGLT2 inhibitors and incretin-based drugs for reducing heart and kidney risks in type 2 diabetes. These benefits occur independently of blood sugar control, meaning they help protect the heart and kidneys even if glucose levels are already managed. Overall, these medications are considered safe and effective tools to reduce complications in high-risk patients with chronic conditions like diabetes and cardiovascular diseases.8,9
These drugs are generally more expensive than traditional diabetes medications. However, the access and cost depend on insurance. On November 6, 2025, the White House announced a deal with major pharmaceuticals to lower prices and expand access to incretin-based drugs for the treatment of diabetes and obesity. Medicare and Medicaid will pay about $245 per month, with Medicare patients paying around $50. The new platform will offer cash prices starting at $350, dropping to $250 in two years, and future oral incretin-based medications could cost $149 per month once approved.10,11
If implemented successfully, it could improve access to these medications and reduce costs, making treatment more affordable for people with chronic conditions like heart disease and diabetes. Currently, these drugs are more expensive in the United States than countries like Canada, Mexico, and several European countries, highlighting the need for better pricing in the United States.
Author Bio
Alireza Hayatshahi, PharmD
Dr. Hayatshahi is an infectious diseases pharmacist. He serves as the Vice Dean of Clinical Affairs at LLU School of Pharmacy. He is a Professor in the Department of Pharmacy Practice, School of Pharmacy, and Department of Dental Education, School of Dentistry. His research interests include interprofessional education, patient-centered collaborative practice, and pharmacotherapy in chronic disease management.
Dr. Hayatshahi is an infectious diseases pharmacist. He serves as the Vice Dean of Clinical Affairs at LLU School of Pharmacy. He is a Professor in the Department of Pharmacy Practice, School of Pharmacy, and Department of Dental Education, School of Dentistry. His research interests include interprofessional education, patient-centered collaborative practice, and pharmacotherapy in chronic disease management.
References:
- Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes-2025. Diabetes Care. 2025;48(Supplement 1): S181-S206. doi:10.2337/dc25-S009.
- Cardiovascular Disease and Risk Management: Standards of Care in Diabetes-2025. Diabetes Care. 2025;48(Supplement 1): S207-S238. doi:10.2337/dc25-S010.
- Kittleson MM, Panjrath GS, Amancherla K, et al. 2023 ACC expert consensus decision pathway on management of heart failure with preserved ejection fraction: a report of the American College of Cardiology solution set oversight committee. J Am Coll Cardiol. 2023;81(18):1835-1878.
- Maddux TM, Januzzi JL, Allen LA, et al. 2024 ACC expert consensus decision pathway on management of heart failure with reduced ejection fraction: a report of the American College of Cardiology solution set oversight committee. J Am Coll Cardiol. 2024;83(15):1444-1488.
- Guidelines for Cardiovascular Risk Reduction in Patients with Type 2 Diabetes: JACC Guideline Comparison. Kelsey MD, Nelson AJ, Green JB, et al. Journal of the American College of Cardiology. 2022;79(18):1849-1857. doi: 10.1016/j.jacc.2022.02.046.
- Clinical Benefit of Cardiorenal Effects of Sodium-Glucose Cotransporter 2 Inhibitors: JACC State-of-the-Art Review. Zelniker TA, Braunwald E. Journal of the American College of Cardiology. 2020;75(4):435-447. doi: 10.1016/j.jacc.2019.11.036.
- Comparative Effectiveness of Second-Line Antihyperglycemic Agents for Cardiovascular Outcomes: A Multinational, Federated Analysis of LEGEND-T2DM. Khera R, Aminorroaya A, Dhingra LS, et al. Journal of the American College of Cardiology. 2024;84(10):904-917. doi: 10.1016/j.jacc.2024.05.069.
- FDA Orange Book. FDA Orange Book.
- Administration Strikes Deal on GLP-1 Drug Pricing and Coverage.18 November 2025 https://www.conference-board.org/research/CED-Newsletters-Alerts/administration-strikes-deal-on-glp1-drug-pricing-and-coverage.
- Medicare Part D Coverage and Costs for Glucagon-Like Peptide-1 Receptor Agonists. Klebanoff MJ, Li P, Long JA, Doshi JA. JAMA. 2025;2839302. doi:10.1001/jama.2025.1584.