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Type 2 Diabetes

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Diabetes affects more than 38 million Americans, with type 2 diabetes accounting for most cases.¹

This module provides clinicians up-to-date evidence-based treatment recommendations for diabetes, including individualized glycemic targets, choice of glucose-lowering medications based on end-organ protection, and strategies to avoid hypoglycemia by adjusting insulin regimens. For resources on preventing diabetes, see our type 2 diabetes – prevention website.

Goals of diabetes management

Reduce the risk of complications from cardiovascular disease, kidney disease, or overweight/obesity
Control blood glucose to reduce microvascular complications (e.g., retinopathy and neuropathy)

For patients with established atherosclerotic cardiovascular disease (ASCVD), high risk for ASCVD, chronic kidney disease, heart failure, overweight/obesity, or metabolic dysfunction-associated steatotic liver disease, starting with or adding a sodium-glucose co-transporter 2 (SGLT-2) inhibitor or a glucagon-like peptide-1 (GLP-1) receptor agonist (RA)-containing medication may be the best choice.²In certain circumstances, one class may be preferred over the other. Metformin remains the foundation of diabetes treatment for patients who don’t meet the above criteria.

Factors for selecting treatment for patients with diabetes

$SGLT-2 inhibitors benefit patients with ASCVD, heart failure with reduced ejection fraction, HF with preserved EF, and chronic kidney disease. GLP-1 RAs benefit patients with ASCVD, CKD, metabolic dysfunction-associated steatotic liver disease (MASL) and overweight/obesity. GIP/GLP-1 RA benefit patients with ASCVD, HF with preserved EF and overweight/obesity. Semaglutide may help with HF with preserved EF. Tirzepatide may help with MASLD.$

Foundations of management

Continuously reinforce dietary changes and physical activity
Assess for barriers to obtaining medications and medication taking behaviors
Adjust treatment based on cost and/or insurance coverage
Optimize doses for other medications before adding insulin

Modifying insulin regimens to avoid hypoglycemia

In older adults, hypoglycemia is associated with falls and cognitive impairment. Reassessing insulin regimens, in some cases replacing insulin with other medications, can help reduce hypoglycemia risk. Ways to reduce hypoglycemia include:

When adding GLP-1 RA medications, reduce basal and bolus insulin doses based on HbA1c levels and glycemic variation, hypoglycemia unawareness, or severe hypoglycemic events.
Simplify insulin regimens to reduce treatment burden and hypoglycemia, without compromising HbA1c, with oral diabetes medications.
Continuous glucose monitors (CGM) can help reduce episodes of hypoglycemia and decrease glycemic variation.

Additional Resources for Providers

Additional Resources for Patients

Information current at time of publication, November 2025.

The content of this website is educational in nature and includes general recommendations only; specific clinical decisions should only be made by a treating clinician based on the individual patient’s clinical condition.

References

Centers for Disease Control and Prevention. National Diabetes Statistics Report. cdc.gov/diabetes/php/data-research/index.html. Accessed October 17, 2025.
American Diabetes Association Professional Practice Committee. Standards of Care in Diabetes-2025. Diabetes Care. 2025;48(1 Suppl 1):S1-S343.
Munshi MN. Continuous Glucose Monitoring Use in Older Adults for Optimal Diabetes Management. Diabetes Technol Ther. 2023 Jun;25(S3):S56-S64.