Type 2 Diabetes: Intensification Beyond Metformin

Metformin remains the foundational agent for T2DM, but >50% of patients require intensification within 3 years. The NP's challenge at intensification is not just picking an antihyperglycemic — it is selecting the agent that simultaneously treats the most important comorbidity risk. GLP-1 receptor agonists and SGLT-2 inhibitors have transformed T2DM management by offering cardiovascular and renal protection independent of A1c lowering. Knowing when and how to prescribe these agents, including dosing, monitoring, and contraindications, is now core NP competency.