. Author manuscript; available in PMC: 2020 Dec 14.

Published in final edited form as: Circulation. 2019 Mar 17;140(11):e596–e646. doi: 10.1161/CIR.0000000000000678

Recommendations for Adults With Type 2 Diabetes Mellitus.

Referenced studies that support recommendations are summarized in Online Data Supplement 10.

COR	LOE	Recommendations
I	A	1. For all adults with T2DM, a tailored nutrition plan focusing on a heart-healthy dietary pattern is recommended to improve glycemic control, achieve weight loss if needed, and improve other ASCVD risk factors.^{S4.2-1,S4.2-2}
I	A	2. Adults with T2DM should perform at least 150 minutes per week of moderate-intensity physical activity or 75 minutes of vigorous-intensity physical activity to improve glycemic control, achieve weight loss if needed, and improve other ASCVD risk factors.^{S4.2-3,S4.2-4}
IIa	B-R	3. For adults with T2DM, it is reasonable to initiate metformin as first-line therapy along with lifestyle therapies at the time of diagnosis to improve glycemic control and reduce ASCVD risk.^{S4.2-5–S4.2-8}
IIb	B-R	4. For adults with T2DM and additional ASCVD risk factors who require glucose-lowering therapy despite initial lifestyle modifications and metformin, it may be reasonable to initiate a sodium-glucose cotransporter 2 (SGLT-2) inhibitor or a glucagon-like peptide-1 receptor (GLP-1R) agonist to improve glycemic control and reduce CVD risk.^{S4.2-9–S4.2-14}