Diabetes: Pharmacotherapy for Type 2 Diabetes.

For most patients with type 2 diabetes, the American Diabetes Association (ADA) recommends an A1c goal of less than 7%. However, this goal may be adjusted depending on certain patient factors. Metformin should be used as a first-line treatment in all patients with type 2 diabetes unless contraindicated. Add-on treatment with a sodium-dependent glucose cotransporter 2 inhibitor or glucagon-like peptide 1 receptor agonist should be considered in patients who have or are at high risk of cardiovascular disease and in patients with kidney disease. Insulins, sulfonylureas, thiazolidinediones, and dipeptidyl-peptidase 4 inhibitors also have roles in management. With use of drugs with varied mechanisms of action, the various pathophysiologic mechanisms responsible for progression of type 2 diabetes can be managed. Microvascular and macrovascular complications of diabetes contribute to significant morbidity and mortality, so evaluation for and management of hypertension, hyperlipidemia, and other associated conditions also are essential.