b'New Focus in the Fight to Reduce CV Risks in Type 2 Diabetesu From Page 25inHines,IL,oneofthethreeleadsuch as sodium-glucose cotransporter 2In the past, the ADA generally hadnt investigatorsontheVADTfollow- (SGLT2) inhibitors and glucagon-likeweighedinmuchonwhatmedica-up.Outsidetherigorsofaprecisepeptide1(GLP-1)receptoragonists,tion should be added to metformin as protocol like the VADT, its easy forthatonlyachievemodestimprove- a second agent in patients with Type 2 patients to let glucose control slip. Itsments in glycemic control highlight thediabetes.a tough disease in many ways. importance of also considering nongly- That stance generally continued in the Remember, there was a significantcemic approaches to reducing the risks2020 Standards of Medical Care, pub-cardiovascular benefit of good sugarofcardiovasculareventsanddeathlished in Diabetes Care, with authors control at 10 years, he pointed out.among high-risk patients with Type 2advising,Thechoiceofmedication So, one interpretation of this is thatdiabetes. addedtometforminisbasedonthe goodglycemiccontrolisbeneficial.Indeed, that appears to be the newclinicalcharacteristicsofthepatient But it must be sustained, or the ben- direction in 2020 guidelines from theand their preferences.2efit is lost. American Diabetes Association. TheFor the first time, however, the ADA Thestudyalsocautionedthatanydocumentrecommendedthat,formadeastrongrecommendationfor benefitsofintensivetherapymustbeType2diabetespatientswhohavewhat drugs should be used in diabetes weighed against adverse effects such ascardiovascular disease or are at highpatients with atherosclerotic cardiovas-hypoglycemia and weight gain.riskforit,anSGLT-2inhibitororcular disease or at high risk for it. The Effect of Intensive Glucose Treatment on Major Cardiovascular Looking at the alternative approach,GLP-1RAshouldbeconsideredaspanel urge strong consideration for the the authors explained, Studies showingoptimal treatmentand that the deci- use of sodium-glucose transport protein Events, Mortality, and Health-Related Quality of Life.* major reductions in the risk of cardio- sion should be made independent of2 inhibitors or glucagon-like peptide-1 vascular outcomes with diabetes agents,hemoglobin A1c levels. receptor agonists.Source: PD Reaven et al. N Engl J Med 2019;380:2215-2224.PD Reaven et al. N Engl J Med 2019;380:2215-2224. 302020 COMPENDIUM OF FEDERAL MEDICINE'