Endocrine & Diabetes

<7% for most adults; individualized (e.g., <8% for limited life expectancy or extensive comorbidity, tighter if achievable without hypoglycemia).

Comorbidities — established ASCVD/high CV risk, heart failure, and CKD favor GLP-1 RA and/or SGLT2 inhibitors independent of metformin/A1c.

Roughly 1-1.5 percentage points (~1-2%).

Decreases hepatic gluconeogenesis (activates AMPK) and improves peripheral insulin sensitivity/glucose uptake; does not stimulate insulin secretion.

Lactic acidosis (rare but serious); risk rises with renal impairment, hypoxic states, hepatic disease, alcohol use, and acute illness.

Contraindicated if eGFR <30 mL/min/1.73m2; do not initiate if eGFR 30-45; if already on it and eGFR falls to 30-45, assess risk/reduce dose.