Over the past decade, the management of type 2 diabetes has transitioned from an emphasis on tight glycemic control to a focus on individualized treatment for each patient that seeks to balance the risk for hyperglycemia against the risk for hypoglycemia.
For individuals with cardiovascular disease (CVD) or multiple cardiovascular risk factors, appropriate choices for second-line therapy should include agents with proven efficacy in improving cardiovascular outcomes.
Patients must participate in self-monitoring of blood glucose, be attentive to symptoms of hypoglycemia, and take appropriate action to address hypoglycemia.
The presence of type 2 diabetes is an established risk factor for cardiovascular disease. The risk of death is elevated in individuals who have both conditions. The risk of incident heart failure in people with type 2 diabetes is twice that of people who do not have diabetes.
The risk for hypoglycemia is highest in elderly patients with renal dysfunction, particularly after inadequate carbohydrate consumption, following strenuous exercise, or with excess alcohol intake.