Another important consideration for optimizing patient presentation and treatment selection will be the patient’s comorbidities, as shown in Figure 13.[2]

For example, with respect to coronary artery disease, multiple iterations of the UK Prospective Diabetes Study (UKPDS) have shown that metformin is associated over time with benefit in cardiovascular disease. On the other hand, use of sulfonylureas (and secretagogues in general) has been associated with long-term cardiovascular disease (CVD) risk, probably because they have more powerful glucose lowering effects and hypoglycemia has been found to increase CVD risk and to be associated with CVD events. Similarly an association between CVD risk and the thiazolidinediones (TZDs), pioglitazone and rosiglitazone, has been suggested, and rosiglitazone was removed from the market for a time because of its association with CVD. Finally, no increased risk of major adverse cardiovascular events has been found with incretin-based therapies. All these considerations are important in choosing among these T2DM medication classes. Kapustin J. J Nurse Pract. 2014; 00:00 – 00.