The requirement to test one new drug in class should be tested in CVOT to give assurance and evidence to treating physicians about its efficacy and safety.

It should be noted that in referring to CVD, we include not only macrovascular but also microvascular morbidity. Both are equally important from a CV outcome point of view.

New and existing glucose-lowering therapies should be evaluated for their overall effects on vascular health, the various CV phenotypes (e.g., heart failure), and specific vascular complications such as amputations.

CVOTs have sensitized diabetes care providers to the opportunities for multifactorial and comprehensive diabetes care, including CV risk reduction.

Some of the more recent CVOTs have embraced comprehensive cardiorenal primary endpoints, originally proposed by investigators from earlier trials.

CVOTs have still a long way to go. Primary intervention trials in lower-risk populations could determine whether diabetes medications offer CV protection for those who do not yet have CVD.