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This article uses a case vignette to address the use of glucose-lowering drugs to reduce cardiovascular disease (CVD) risk in individuals with type 2 diabetes (T2D). The author presents the clinical problem, discusses treatment strategies and supporting evidence for different treatment options, and provides an approach to the use of glucose-lowering medications in patients with T2D to lower CVD risk.
The author highlights the use of sodium–glucose co-transporter 2 (SGLT2) inhibitors in patients with diabetes with established CVD or, in select cases, in those at high risk for CVD. The demonstrated benefit of using SGLT2 inhibitors in patients with a history of heart failure is also discussed.
In patients with type 2 diabetes and established cardiovascular disease (or in those with a high risk of cardiovascular disease) in whom glycemic goals are not achieved with metformin, agents from the GLP-1 receptor agonist or SGLT2 inhibitor classes with demonstrated cardiovascular benefit constitute the recommended treatment.