• Macrovascular damage starts many years before the onset of diabetes.
• Insulin resistance (IR) and its complications and β-cell preservation have to be adequately addressed for positive long-term outcomes.
• If IR is treated right from day 1, we will see lesser macrovascular complications.
• Metformin + pioglitazone most durable, less weight gain with metformin in place.
• Add an SGLT inhibitor and that’s an unbeatable combination.
• Metformin + pioglitazone gives the best results - when endogenous insulin is present.

Metformin + pioglitazone + SGLT inhibitors with endogenous insulin - EARLY USE = INTELLIGENT USE