The Diabetes Staging System in Patient Aligned Care Teams

Eligibility Criteria

• * male or female
• * prior history of cardiovascular disease (myocardial infraction, cardiac stents, coronary artery pass, diastolic/systolic heart failure, stroke, carotid endarterectomy, femoral popliteal bypass, abdominal aortic aneurysm)
• * prior history of chronic kidney disease (GFR \<60, microalbumin creatinine/ratio \>30 mg/g - creatinine on 3 separate occasions)
• * age 25-75 years
• * BMI \>27
• * diagnosis of type 2 diabetes
• * hemoglobin A1C \>7.0%
• * agreeable to regular visits per study protocol
• * access to telephone and reliable transportation and has an assigned PACT provider using a Freestyle Libre 2 or Freestyle lite glucometer to monitor blood sugars or willing to monitor blood sugars during study
• * age \>75,
• * A1C \<7%
• * GFR \<30
• * pregnant
• * breast feeding
• * prior history of pancreatitis will lead to avoidance of GLP-1 agonist therapy but not SGLT2i
• * prior history of gastroparesis, dysphagia will lead to avoidance of GLP-1 agonist therapy but not SGLT2i
• * history of thyroid cancer/multiple endocrine neoplasia/thyroid nodules/medullary thyroid cancer (contraindication to Liraglutide) will lead to avoidance of GLP-1 agonist therapy but not SGLT2i
• * history of gallstones will lead to avoidance of GLP-1 agonist therapy but not SGLT2i history of hyperoxaluria or calcium oxalate nephrolithiasis will lead to avoidance of GLP-1 agonist therapy but not SGLT2i
• * history of Roux-en-Y gastric bypass or gastric sleeve or any other bariatric procedure will lead to avoidance of GLP-1 agonist therapy but not SGLT2i
• * type 1 diabetes
• * any gastrointestinal condition causing malabsorption (including but not limited to inflammatory bowel disease, celiac sprue) will lead to avoidance of GLP-1 agonist therapy but not SGLT2i
• * prior history of urinary tract infections will lead to avoidance of SGLT2i but not GLP-1 agonist therapy
• * prior h/o recurrent yeast infections will lead to avoidance of SGLT2i but not GLP-1 agonist therapy
• * uncircumcised male will lead to avoidance of SGLT2i but not GLP-1 agonist therapy prior h/o toe or lower extremity amputations will lead to avoidance of SGLT2i but not GLP-1 agonist therapy
• * active diabetic foot ulcers or osteomyelitis will lead to avoidance of SGLT2i but not GLP-1 agonist therapy
• * unwilling or unable to complete scheduled testing
• * any serious and/or unstable medical, psychiatric, or other condition(s) that prevents the patient from providing informed consent or complying with the study
• * organ transplantation or those on immunosuppressants
• * chronic anticoagulation
• * recent myocardial infarction, unstable angina, stroke, coronary artery bypass or transient ischemia attacks in the past 6 months
• * chronic prednisone use
• * deep vein thrombosis in past 6 months
• * active malignancy-unstable psychiatric condition including active or current suicidal ideation
• * Enrolled in another research study related to diet and/or physical activity