Funded out Association’s general revenues and does not use industry support. Funded out Association’s general revenues and does not use industry support

Metformin, if not contraindicated and if tolerated, is the preferred initial pharmacologic agent for T2DM. A

• Metformin, if not contraindicated and if tolerated, is the preferred initial pharmacologic agent for T2DM. A

• Consider insulin therapy (with or without additional agents) in patients with newly dx’d T2DM who are markedly symptomatic and/or have elevated blood glucose levels (>300 mg/dL) or A1C (>10%). E

Long-term use of metformin may be associated with biochemical vitamin B12 deficiency, and periodic measurement of vitamin B12 levels should be considered in metformin-treated patients, especially in those with anemia or peripheral neuropathy. B

• Long-term use of metformin may be associated with biochemical vitamin B12 deficiency, and periodic measurement of vitamin B12 levels should be considered in metformin-treated patients, especially in those with anemia or peripheral neuropathy. B

If noninsulin monotherapy at maximal tolerated dose does not achieve or maintain the A1C target over 3 months, add a second oral agent, a GLP-1 receptor agonist, or basal insulin. A

• If noninsulin monotherapy at maximal tolerated dose does not achieve or maintain the A1C target over 3 months, add a second oral agent, a GLP-1 receptor agonist, or basal insulin. A

• Use a patient-centered approach to guide choice of pharmacologic agents. E

• Don’t delay insulin initiation in patients not achieving glycemic goals. B

The progressive nature of T2DM should be regularly & objectively explained to T2DM patients.

• The progressive nature of T2DM should be regularly & objectively explained to T2DM patients.

• Avoid using insulin as a threat, describing it as a failure or punishment.

• Give patients a self-titration algorithm.

In patients with long-standing suboptimally controlled type 2 diabetes and established atherosclerotic cardiovascular disease, empagliflozin or liraglutide should be considered as they have been shown to reduce cardiovascular and all-cause mortality when added to standard care. Ongoing studies are investigating the cardiovascular benefits of other agents in these drug classes. B

• In patients with long-standing suboptimally controlled type 2 diabetes and established atherosclerotic cardiovascular disease, empagliflozin or liraglutide should be considered as they have been shown to reduce cardiovascular and all-cause mortality when added to standard care. Ongoing studies are investigating the cardiovascular benefits of other agents in these drug classes. B

CVD is the leading cause of morbidity & mortality for those with diabetes.

• CVD is the leading cause of morbidity & mortality for those with diabetes.

• Largest contributor to direct/indirect costs

• Common conditions coexisting with type 2 diabetes (e.g., hypertension, dyslipidemia) are clear risk factors for ASCVD.

• Diabetes itself confers independent risk

• Control individual cardiovascular risk factors to prevent/slow CVD in people with diabetes.

• Systematically assess all patients with diabetes for cardiovascular risk factors.

Common DM comorbidity

• Common DM comorbidity

• Prevalence depends on diabetes type, age, BMI, ethnicity

• Major risk factor for ASCVD & microvascular complications

• In T1DM, HTN often results from underlying kidney disease.

• In T2DM, HTN coexists with other cardiometabolic risk factors.

Action to Control Cardiovascular Risk in Diabetes (ACCORD):

• Action to Control Cardiovascular Risk in Diabetes (ACCORD):

• Does SBP <120 provide better cardiovascular protection than SBP 130-140? No.

• ADVANCE-BP:

• Significant risk reduction

Screening and Diagnosis:

• Screening and Diagnosis:

• Blood pressure should be measured at every routine visit. B

• Patients found to have elevated blood pressure should have blood pressure confirmed on a separate day. B

Systolic Targets:

• Systolic Targets:

• People with diabetes and hypertension should be treated to a systolic blood pressure goal of <140 mmHg. A

• Lower systolic targets, such as <130 mmHg, may be appropriate for certain individuals at high risk of CVD, if they can be achieved without undue treatment burden. C

Diastolic Targets:

• Diastolic Targets:

• Patients with diabetes should be treated to a diastolic blood pressure <90 mmHg. A

• Lower diastolic targets, such as <80 mmHg, may be appropriate for certain individuals at high risk for CVD if they can be achieved without undue treatment burden. C