Diabetes is a health condition in which the body is unable to properly use glucose (sugar) for energy resulting in high levels of blood glucose (hyperglycemia). In type 2 diabetes, either the pancreas does not produce an adequate amount of insulin or the body cannot respond properly to insulin. Type 2 diabetes is becoming more prevalent among children and young adults. Over time, high blood glucose damages nerves and blood vessels, leading to complications such as stroke, blindness, heart disease, kidney failure, the risk of getting cancer and lower limb amputations.

Currently, 387 million people are diagnosed with diabetes, and at least 68% of the patients that are older than 65 years old die of heart disease. The American Diabetes Association (ADA) guidelines recommend angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARBs) for all diabetic patients to reduce heart and kidney-related complications. 

Metformin (Glucophage) and pioglitazone (Actos) have supporting evidence for reducing cardiovascular (heart and circulatory system) related events. Metformin is the first-line treatment for type 2 diabetes. In the U.K. Prospective Diabetes Study (UKPDS), metformin reduced the risk of heart attacks in overweight diabetic patients when compared to patients that received insulin or a sulfonylurea. 

Pioglitazone (Actos) reduces blood pressure, improves endothelial function, and has beneficial effects on cholesterol profile, and atherosclerosis. Pioglitazone significantly reduced a secondary composite end point of all-cause mortality, nonfatal myocardial infarction, and stroke in one study. However, pioglitazone is also known to cause weight gain, fluid retention, and worsen heart failure. 

A newer glucose lowering agent, empagliflozin (Jardiance), is the first anti-diabetic drug to show a reduction in death due to cardiovascular events.

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