Choice of Antidiabetic Agents in Patients With SIHD and Diabetes

Mr. Smith is a 58-year-old male patient with hypertension, dyslipidemia, stable ischemic heart disease, and type 2 diabetes mellitus. He presents to your clinic for routine follow-up of his stable ischemic heart disease. He has no new concerning cardiac symptoms and good exercise capacity.

His medications include aspirin 81 mg once daily, bisoprolol 5 mg once daily, perindopril 4 mg once daily, atorvastatin 40 mg once nightly, and metformin 1,000 mg twice daily.

His electrolytes and creatinine remain in the normal range. His low-density lipoprotein is at 60 mg/dL. His HbA1c is 8.3% (8.3% = 67 mmol/mol = 192 mg/dL).

Aside from further lifestyle advice, what additional pharmacotherapeutic strategy has been shown to improve both glycemic control and reduce cardiovascular events while lowering all-cause mortality?

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