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Comparing Medications for Adults With Type 2 Diabetes

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Background: Management

Management of hyperglycemia using diet and pharmacologic therapy is a very important part of treatment for type 2 diabetes. Results from randomized controlled trials (RCTs) have demonstrated that the risk of microvascular complications, particularly retinopathy, can be reduced by improved glycemic control in patients with type 2 diabetes. However, studies have had mixed results regarding the impact of intensive glycemic control (hemoglobin A1c [HbA1c] < 7 percent) on cardiovascular events and mortality. While older studies indicated that intensive glycemic control may reduce cardiovascular morbidity and mortality, recent studies have raised the possibility that  intensive glycemic control has either no effect or a negative effect on cardiovascular morbidity and mortality. These mixed results suggest the need for further research, including investigation of the long-term safety of glucose-lowering therapies. In addition to questions about optimal glycemic control, recent studies have addressed concerns about excess cardiovascular risk associated with particular hypoglycemic agents, specifically the risk of rosiglitazone.