Diabetes Update: Beyond Glycemic Management

June, 2021

• Despite advances in treatments for diabetes, many people still struggle to reach American Diabetes Association recommended goals: an A1c less than 7% (for most adults), a blood pressure less than 140 mmHg/90 mmHg, appropriate lipid levels, and improved weight.
• More than 80% of people with diabetes are overweight or obese. Obesity is linked with coronary heart disease and end-stage kidney disease – common complications related to diabetes.
• Metformin is considered first line treatment for most people with diabetes. However, its ability to control glucose is often not sustainable; patients frequently require the addition of a 2nd glucose-lowering medication.
• Because of favorable cardiovascular and kidney effects, glucagon-like peptide-1 (GLP-1) agonists and sodium glucose co-transporter-2 inhibitors (SGLT-2i) are gaining a preferred place in therapy for type 2 diabetes.
• People with type 2 diabetes and established or high-risk cardiovascular disease, kidney disease, or heart failure should use a GLP-1 agonist or SGLT-2i with demonstrated CVD benefit. These medications are also recommended if striving for weight loss or when there is considerable risk of hypoglycemia.

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