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hello everyone I am pratibha Rao an adult endocrinologist at the Cleveland Clinic and Im here today to discuss with you the evidence-based management of type 2 diabetes with atherosclerotic cardiovascular disease CKD or heart failure well do this in a case-based presentation and lets start off with case one the learning objectives after completing these cases the reader should be able to identify indications and contraindications for glp-1 receptor Agonist therapy in short Ill be referring to them as glp1 recep 1ra summarize the literature on cardiovascular disease and CKD or chronic kidney disease reduction with glp-1 receptor agonis review how to prescribe common glp-1ra agents recognize and manage adverse effects from glp-1ra medications so lets start a 65 year old man presents for type 2 diabetes diabetes was diagnosed eight years ago his most recent A1C was 8.3 percent on Metformin 1000 milligrams twice daily he does not have any known microvascular complications from diabet