Figure 1.

Flowchart of drug therapy for type 2 diabetes mellitus. T2DM: type 2 diabetes mellitus; ASCVD: atherosclerotic cardiovascular disease; HF: heart failure; CKD: chronic kidney disease; GLP-1RA: glucagon-like peptide-1 receptor agonist; SGLT-2i: sodium-glucose cotransporter-2 inhibitor; DPP-4i: dipeptidyl peptidase-4 inhibitor. (a) If patients have an estimated glomerular filtration rate (eGFR) <45 mL/min/1.73 m², use of SGLT-2is and metformin is not recommended; it is suggested to select GLP-1RAs or DPP-4is, which have evidence of renal benefits. (b) For patients with T2DM who have HF, the use of SGLT-2is and metformin is not recommended with eGFR <45 mL/min/1.73 m²; it is preferable to use GLP-1RAs, which have evidence of cardiovascular benefit.