b'Effect of Intensive Glucose Therapy on Major Cardiovascular New Focus in the Fight to Reduce CV Risks in Type 2 DiabetesEvents during Periods of Separation of Glycated Hemoglobin Curves (Years 010) and No Separation (Years 1115).* 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.glucose-lowering regimen independentASCVD or significant risk factors.For patients with established ASCVD or indicators of high ASCVD risk (suchof A1c and in consideration of patient- Acomparativeeffectivenessmeta-as patients 55 years of age with coro- specific factors, the ADA wrote in theanalysis suggests that each new class nary, carotid, or lower-extremity arteryrevised statement. ofnoninsulinagentsaddedtoinitial stenosis 50% or left ventricular hyper- Thestandardspointedoutthat,therapy with metformin generally low-trophy), established kidney disease, ordespite numerous trials comparing dualersA1Capproximately0.71.0%, heartfailure,anSGLT-2inhibitorortherapy with metformin alone, there isaccording to the document. if the A1c GLP-1RAwithdemonstratedCVDlittle evidence to support one combina- targetisnotachievedafterapproxi-benefit is recommended as part of thetion over another for patients withoutmately three months, metformin can be 2020 COMPENDIUM OF FEDERAL MEDICINE 31'