In adults with type 2 diabetes and established atherosclerotic cardiovascular disease (ASCVD), or those at high cardiovascular risk, medication selection addresses both glycemic control and cardiovascular event reduction as co-equal priorities.
This protocol applies to adults with type 2 diabetes who have established atherosclerotic cardiovascular disease, or who meet indicators of high cardiovascular risk — typically age ≥55 years with two or more additional risk factors such as obesity, hypertension, smoking, dyslipidemia, or albuminuria. In this population, cardiovascular benefit is a primary driver of treatment selection.
Evidence-based management in this setting prioritises agents specifically selected for their demonstrated ability to reduce cardiovascular events — used independent of baseline A1C levels. The choice and combination of agents is guided by individual clinical factors.
The complete regimen, agent selection criteria, and decision pathways are available in the full protocol below.
DOI: 10.2337/dc26-S009
In adults with type 2 diabetes and established or high risk of atherosclerotic cardiovascular disease, the treatment plan should include medications with demonstrated benefits to reduce cardiovascular events (e.g., glucagon-like peptide 1 receptor agonist [GLP-1 RA] and/or sodium–glucose cotransporter 2 [SGLT2] inhibitor) for glycemic management and comprehensive cardiovascular risk reduction (irrespective of A1C) (Fig. 9.4 and Table 9.2).
For people with type 2 diabetes and established ASCVD or indicators of high ASCVD risk, HF, or CKD, an SGLT2 inhibitor and/or GLP-1 RA with demonstrated cardiovascular benefit (Table 9.2) is recommended independent of A1C, with or without metformin use, and in consideration of person-specific factors (Fig. 9.4).
Indicators of high risk: While definitions vary, most comprise ≥55 years of age with two or more additional risk factors (including obesity, hypertension, smoking, dyslipidemia, or albuminuria).
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