One of the most fascinating things is watching the science of a disease process improve,

such as in type 2 diabetes. So when I was a medical student, resident, early years of an attending

physician, there really since then has been a paradigm shift. So we've always known that diabetes

is a horrendous cardiovascular risk factor, meaning it causes

coronary disease and kidney disease and amputations and you can go down the list.

But what was accepted for the longest period of time is this focus on glucose lowering.

But the paradigm shift really has occurred that there are

a lot of different glucose-lowering anti-hyperglycemic agents. And despite different classes of

medications that lower glucose often very similarly as far as how low the glucose gets lowered,

there is a difference in their cardiovascular outcomes. The focus solely on sugar, how low we can get

the hemoglobin A1C, how low we can keep the sugars solely as an outcome has pretty much gone away, meaning what we

really care about now is are we going to make an impact by lowering that sugar and attending

to other cardiovascular mortality issues? And that's not to say that blood sugar isn't important. It's very important

because improved glycemic control is associated with reduced microvascular complications. And those

microvascular complications can really affect a person's quality of life. Each of us has our

own philosophies, but I'm of the philosophy

only for myself that I would rather have quality over quantity. So for me, going blind or

developing dementia or needing to be on dialysis, those are really important issues if I were

diabetic. So improve glycema control for the

reduction of those issues by improving the risk factors so I don't develop microvascular disease

is very important. But what we have longed for is also to reduce macrobascular complications

and overall mortality. And that really in the past has not

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