Dr. Prakash Deedwania argues that SGLT2 inhibitors and GLP-1 receptor agonists have shifted diabetes management from simple glucose lowering to comprehensive cardiorenal protection.

The traditional focus on lowering blood glucose is rapidly being superseded by a clinical mandate for organ protection. This shift addresses the high mortality associated with heart failure and chronic kidney disease in patients with metabolic dysfunction.

Managing cardiorenal risk requires moving beyond historical glycemic targets. Clinicians face a persistent practice gap where older glucose-lowering therapies fail to halt the progressive trajectory of macrovascular and microvascular complications.

In an interview at TheRightDoctors studio at the 4th World Congress on Cardio-Kidney-Metabolic Medicine (WCCKMM 2026) at the Leela, Mumbai, Dr. P. C. Manoria, Executive President, spoke with Dr. Professor Prakash Deedwania, Professor of Medicine, UCSF, USA, on current issues in diabetes.

Probing the clinical gap, Dr. P. C. Manoria asked whether SGLT2 inhibitors should now be utilized in almost all type 2 diabetes patients. Dr. Deedwania noted that SGLT2 inhibitors provide a unique natriuretic and osmotic diuretic effect.

Responding to Dr. P. C. Manoria's question, Dr. Deedwania clarified that these agents decrease heart failure hospitalizations and the development of the condition itself. He argued that metformin has been put by the wayside due to a lack of robust cardiovascular data.

Dr. P. C. Manoria highlighted the generic availability of GLP-1 receptor agonists in India. Dr. Deedwania stated that combining the two classes provides complementary benefits, protecting patients against heart failure, renal failure, and atherosclerotic events.

Turning to obesity management, Dr. P. C. Manoria asked how clinicians should select between semaglutide and tirzepatide. Dr. Deedwania noted that while more data exists for semaglutide, tirzepatide demonstrates equivalent benefits and may be better tolerated.

Dr. P. C. Manoria raised the real-world challenge of long-term adherence to weight reduction drugs. Dr. Deedwania suggested these agents serve as an initial kickoff, stating that early weight loss often empowers patients to successfully initiate lifestyle modifications.

Addressing technological integration, Dr. P. C. Manoria and Dr. Deedwania evaluated digital health tools. Dr. Deedwania stated that artificial intelligence can accumulate vast cumulative risk data, providing critical feedback loops for both busy clinicians and patients.

Can the "legacy effect" observed in some semaglutide studies provide a viable exit pathway for patients, or must these agents be continued indefinitely to prevent weight regain? This remains an unresolved clinical question surfaced during the dialogue by Dr. Prakash Deedwania.

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