Questioning Medicine

https://www.acpjournals.org/doi/10.7326/M20-2470 Pharmacologic Approaches to Glycemic Treatment of Type 2 Diabetes: Synopsis of the 2020 American Diabetes Association's Standards of Medical Care in Diabetes Clinical GuidelineFREEWhich is as the artciel suggest in a sypnopsis of the 2020 ADA guidelines metformin is still universal fist line but now the guideline says The choice of agent to add to metformin therapy should be individualized on the basis of patient characteristics, preferences, and drug-specific effects. The big rec from this paper isAmong patients with type 2 diabetes who have established ASCVD or established kidney disease, or heart failure, a sodium–glucose cotransporter-2 (SGLT2) inhibitor or glucagon-like peptide-1 receptor agonist (GLP-1 RA) with demonstrated cardiovascular disease benefit is recommended (Grade A recommendation). they go on to say maybe one of the key lines--------The addition of these medications should be considered independent from HbA1c level in this patient population