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Recent trials of two classes of glucose-lowering drugs (SGLT2 inhibitors and GLP1RAs) have shown consistent cardiovascular and renal benefits that appear independent of glycaemic control. These results have prompted the Dutch College of General Practitioners (NHG) together with the Dutch Society of Internal Medicine (NIV) to update the treatment algorithm in patients with type 2 diabetes mellitus (T2D) at very high CVD risk. The use of SGLT2 inhibitors or GLP1RAs is now recommended in 3 groups of people with T2D. 1. patients with established CVD; 2. Patients with chronic kidney disease and a moderately to high CVD risk according to KDIGO; 3. patients with heart failure with reduced ejection fraction (HFrEF). Treatment algorithms differ for drug-naïve and drug-treated patients with T2D. In both drug-naïve and drug-treated patients the use of a SGLT2 inhibitor respectively as monotherapy or add-on is recommended as first step. If HbA1c is above the individual target, metformin will be added in drug-naive patients whereas GLP1-RAs could be considered in drug-treated patients. GLP1-RAs should also be considered when SGLT2-inhibitors are contraindicated.

Hart HE, Woudstra JG, Rutten GEHM. Screen metforminegebruikers op vitamine B12! Huisarts Wet 2012;55(10):444-7.

Tritiated latex particles and scintillant latex particles have been covalently coated with an antigen (human albumin) and both types of particles are than combined in dilute aqueous suspensions. The formation of antibody-induced dimer and higher-order aggregation resulted in scintillations that could be measured in a standard liquid-scintillation counter, energy-gated for H-3. Rabbit anti-human antiserum was easily detected at a titer of 1:10(6). Human albumin, in the inhibition mode, was also easily detected at 0.1 ng/ml. Since the samples are nondestructively assased, it was possible to examine the kinetics of aggregation under a variety of conditions.