Blood pressure control and lipid management are important to reduce the risk of macrovascular complications such as heart attack and stroke. Glycemic control and blood pressure management reduce the risk of microvascular complications (neuropathy, nephropathy, retinopathy).
A primary goal of care is treatment of cardiovascular risk factors to individualized targets: BP <140/90 mmHg, statin use with target LDL-cholesterol <100 mg/dL, aspirin use for patients with known coronary heart disease, ACE inhibitors for patients with proteinuria, and smoking cessation. More aggressive targets for these risk factors (e.g., BP <130/80 mmHg, LDL <70 mg/dL, aspirin use for primary cardiovascular prevention) are sometimes appropriate for patients based on individualized risk versus benefit considerations.
Lifestyle changes plus metformin are initial antihyperglycemic therapy for most patients.