Abstract

The management of type 2 diabetes has become increasingly challenging where management decision choices should be focusing on reducing hypoglycemia while reducing end organ effects, particularly cardiovascular disease, nonalcoholic fatty liver disease, and renal insufficiency. Intensification of diabetes management should be exercised every 3 months according to most published consensus statements; however, hemoglobin A1c targets need to be individualized based on existing comorbidities and age. The recent revision of the consensus statement of the American diabetes Association, as well as the American Association of Clinical Endocrinologists still advocates metformin as initial monotherapy as adjunct to diet and exercise in those patients that have been diagnosed with type 2 diabetes. Often times, intensification will need to be exercised. Such options should be based on cardiovascular risk, need for weight loss, need to avoid hypoglycemia, and in those circumstances where cost may be an issue. During the development program of most of these newer agents, certain combinations have been studied and these include the GLP-1 receptor agonists and the SGL T2 inhibitors which seem to provide an additive benefit in curtailing the challenge of glycemic control while mitigating cardiovascular risk.

Keywords

GLP-1, SGL T2 inhibitor, diabetes, cardiovascular disease, congestive heart failure, weight loss, systolic blood pressure, chronic kidney disease, incretin, major adverse cardiovascular event, type 2 diabetes