In adults with type 2 diabetes who have established atherosclerotic cardiovascular disease — or who are at high cardiovascular risk — treatment decisions go beyond glycaemic control alone. The protocol below addresses both goals together.

Clinical Scenario

This protocol applies to patients with established atherosclerotic cardiovascular disease, or those who meet criteria for high cardiovascular risk: broadly defined as age 55 or older combined with two or more additional cardiovascular risk factors. In this population, the choice of glucose-lowering therapy is guided by demonstrated cardiovascular outcome evidence, independent of A1C level.

Treatment Overview (partial)

The structured regimen centres on agents with proven cardiovascular benefit. Depending on what therapy a patient is already receiving, the protocol specifies a complementary agent to add. A third option is also considered in specific circumstances. The full combination strategy, sequencing criteria, and supporting evidence are in the complete protocol.

References

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).
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).
For individuals on a GLP-1 RA, consider adding SGLT2i with proven CVD benefit or vice versa.

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Treatment of Type 2 Diabetes with Established Atherosclerotic Cardiovascular Disease

References