A peer-level look at how healthcare professionals balance glycemic control, obesity, kidney function, cardiovascular risk, access, tolerability, and adherence when diabetes management becomes more complex.
Audience: Diabetes-care HCPs
Countries: 6
Completion Rate: 69.6%
SGID: 9001530
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– Quick Read — Key Findings
When diabetes coexists with obesity, CKD, cardiovascular disease, hypoglycemia risk, treatment burden, or financial constraints, the next clinical decision is rarely driven by one number alone.
The ADA 2026 Standards of Care recommend person-centered treatment selection that weighs cardiovascular and kidney disease, weight, hypoglycemia risk, cost and access, tolerability, and preferences alongside glycemic effectiveness. The MDForLives data reflect the same tension: HbA1c remains the most selected assessment, yet cardiorenal outcomes, obesity, adherence, and access repeatedly change what clinicians prioritize.
55.3% say HbA1c and the glucose profile most influence treatment decisions, while 23.7% select eGFR and albuminuria.
Glycemia remains the most visible signal: HbA1c and glucose patterns lead at 55.3%. But eGFR and albuminuria already rank second at 23.7%, showing kidney markers are shaping decisions, because diabetes care increasingly links therapy choice to organ protection, not only glucose lowering.
57.9% select obesity, compared with 31.6% for chronic kidney disease and 10.5% for cardiovascular disease.
The ADA 2026 obesity guidance treats weight management as a core therapeutic goal in type 2 diabetes with overweight or obesity, not an adjunct to glucose control. That helps explain why obesity leads this question at 57.9%, ahead of CKD at 31.6%: weight shapes therapy choice, tolerability, insulin needs, cardiovascular risk and long-term burden at once.
Metformin-based therapy and GLP-1 receptor agonists are tied at 33.3% as the initial priority; after inadequate glycemic control, 44.4% prefer adding an SGLT2 inhibitor.
These results do not establish one universal sequence. Initial therapy is evenly split, but when control stays inadequate, 44.4% add an SGLT2 inhibitor and 33.3% a GLP-1 receptor agonist, favoring agents that address cardiorenal priorities as well as glucose.
34.3% say advanced CKD most changes their treatment strategy, followed by heart failure at 25.7%.
Current ADA CKD guidance and cardiovascular guidance connect glucose-lowering therapy with kidney and cardiovascular outcomes. Here, advanced CKD (34.3%) and heart failure (25.7%) are the subgroups most likely to change strategy, suggesting HCPs treat comorbidity as a reason to re-sequence therapy, not just add another target.
42.9% select cardiovascular risk reduction, followed by weight reduction at 28.6% and kidney protection at 20.0%.
That cardiovascular risk reduction (42.9%) outranks glucose as a reason to continue therapy is one of the clearest signs the objective is broader than HbA1c. The ADA 2026 Standards recommend SGLT2 inhibitors and/or GLP-1 receptor agonists with demonstrated benefit for appropriate people with ASCVD, heart failure or CKD, irrespective of additional glucose-lowering need.
Poor treatment adherence leads the complex-care barrier question at 45.7%; medication affordability follows at 34.3%. Separately, 38.9% say cost or access most limits treatment optimization.
The ADA 2026 systems-of-care guidance emphasizes timely evidence-based decisions, person-centered team care and informed financial discussion. It is directly relevant here: with poor adherence (45.7%) and affordability (34.3%) the leading barriers, the clinically preferred therapy can still fail as a plan if it is unaffordable, hard to tolerate, too complex or not sustained.
The survey shows a tension HCPs will recognize: HbA1c remains central, yet the decision increasingly accounts for obesity, kidney function, cardiovascular risk, weight, tolerability, affordability and whether the patient can sustain the regimen.
That explains why SGLT2 inhibitors and GLP-1 receptor agonists feature prominently, why advanced CKD changes strategy most often, and why cardiovascular risk reduction can justify continuing therapy even when HbA1c is not yet optimal. The target is no longer one outcome delivered by one sequence.
The other side is implementation: poor adherence and affordability lead the barriers, and a clinically sophisticated regimen only helps when the patient can obtain, tolerate, understand and continue it.
The direction the data suggest is more integrated: detect cardiorenal risk earlier, choose therapy around the whole risk profile, define benefit beyond HbA1c, and surface practical barriers before they become treatment failure.
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Direct answers to common professional questions about cardiorenal risk, obesity, treatment selection, access, and outcomes beyond HbA1c.
Direct answers to the questions healthcare professionals are most likely to ask about these findings.
