Type 2 diabetes(T2D)

Type 2 diabetes is diagnosed when fasting blood glucose reaches 126 mg/dL or above, or HbA1c hits 6.5% or higher on two separate tests. About 32 million American adults have it, and another 96 million have prediabetes — an A1C of 5.7 to 6.4% that often goes undiagnosed for years. The condition starts with insulin resistance: muscle, fat, and liver cells stop responding normally to insulin, so the pancreas pumps out more to compensate. Over years, the pancreas tires, output falls, and blood sugar rises chronically. Left uncontrolled, the excess glucose damages small blood vessels, leading to diabetic kidney disease, neuropathy (numbness and pain in feet and hands), and retinopathy (the leading cause of adult blindness in the US). Two GLP-1 medications — semaglutide and tirzepatide — are FDA-approved for type 2 diabetes. They lower A1C by 1.0 to 2.0 percentage points on average and cause meaningful weight loss, which itself improves insulin sensitivity. The LEADER trial showed liraglutide reduced major cardiac events in high-risk T2D patients by 13%. SUSTAIN-6 showed semaglutide reduced the same endpoint by 26%. These are not modest findings. Standard prescribing sequence: metformin is started first, unless contraindicated. If A1C remains above target after 3 months, guidelines from the American Diabetes Association (2024 Standards of Care) recommend adding a GLP-1 agonist or SGLT2 inhibitor, with GLP-1 preferred when weight loss or cardiovascular protection is a priority. Telehealth providers can prescribe GLP-1s for T2D in most US states; several accept Medicare Part D.