Glucose-lowering medications have been the mainstay of managing type 2 diabetes for 20 years, but in April this year a polemic erupted around specific targets for blood sugar. The American College of Physicians recommended less stringent control than had been previously accepted, and invoked fierce criticism from other diabetes organisations around the world.It all comes down to the interpretation of four key trials between designed to show a link between intensive glycemic control and improvement in cardiovascular symptoms. On this episode, Dr Paul Drury and Professor Sophia Zoungas help make sense of the inconsistencies between the findings and explain how these inform individualised strategies for patients with different historiesIn recent years there have also been trials of new drug classes that don't just lower blood glucose but appear to provide cardiovascular benefits directly in sicker patients. These are the SGLT2 inhibitors and GLP-1 receptor agonists, and we'll summarise the use advised in a very recent consensus statement.Guests Professor Sophia Zoungas FRACP (Monash Health; Board Director, Diabetes Australia; Clinical Director, National Association of Diabetes Centres) Dr Paul Drury FRACP (Clinical Advisor in Diabetes, Ministry of Health)Production Written and produced by Mic Cavazzini. Recording assistance in Auckland from Alex Aylett-McMillan and in Melbourne from Rebecca Fary. Music under licence from Epidemic Sound ('Fields' and 'World Joy' by Gunnar Johnsén, 'Organic Textures' by Johannes Bornlöf). Image under licence from iStock. The production manager was Anne Fredrickson. Editorial feedback for this episode was provided by RACP Fellows Paul Jauncey, Michael Herd, Phillip Gaughwin, Mahesh Dhakal, Marion Leighton, Rebecca Grainger, Rhiannon Mellor, and Alan Ngo. Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.

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