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Intimately linked to T2DM and CV disease is obesity and this is another
area where certain agents may offer significant benefits. It is well known
that some compounds, such as SUs, non-SU secretagogues, insulin and
TZDs are associated with significant increases in weight. However, the
15
incretin therapies, with their novel mode of action, and several of the
emerging therapies are weight neutral or associated with significant
weight loss (reviewed in Chapter 4), which has implications for lipid-
aemia and patient quality of life.
In addition to potential CV protection afforded by some drugs there
is also intriguing evidence that certain T2DM treatments may even re-
duce the risk of developing cancer. A cohort study has demonstrated
that metformin use reduces the risk of developing cancer by 37%, even
after taking into account various factors such as age, blood sugar con-
trol, smoking and weight. The authors of this study conclude “a ran-
89
domised trial is needed to assess whether metformin is protective in a
population at high risk for cancer.” Treatments such as metformin re-
89
duce insulin resistance and it has been suggested that insulin resistance
is associated with an increased risk of cancer. Correspondingly, it has
90
been found that SUs are associated with a higher risk of cancer-related
mortality than metformin. 91

We are still largely in the dark with respect to the full range of effects
associated with the use of T2DM treatments. The ongoing CV outcome
studies outlined earlier in this chapter will go some way to defining the
degree to which several of these treatments influence CV risk, but this
may represent the tip of the physiological iceberg. The widely used
medications used in the treatment of T2DM may have effects way be-
yond lowering glycaemia and improving the various risk factors of CV
disease.

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