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(Proposed catalytic cycle: Fig

Compounded drugs are customized medications created by pharmacists who mix, alter, or combine ingredients to meet the specific needs of a patient

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Here are the key recommendations: 1 Type 2 Diabetes with No Relevant Comorbidities First-line therapy: Modified-release Metformin + SGLT2 inhibitor If Metformin is contraindicated or not tolerated: SGLT2 inhibitor monotherapy 2 Type 2 Diabetes with Heart Failure Initial therapy: Modified-release Metformin + SGLT2 inhibitor If Metformin cannot be used: SGLT2 inhibitor alone 3 Type 2 Diabetes with Atherosclerotic Cardiovascular Disease (ASCVD) Recommended combination therapy: Metformin SGLT2 inhibitor Semaglutide (up to 1 mg weekly) If Metformin is contraindicated: SGLT2 inhibitor + Semaglutide 4 Early-Onset Type 2 Diabetes Initial treatment: Modified-release Metformin + SGLT2 inhibitor Consider adding: GLP-1 receptor agonist or Tirzepatide for improved glycemic and cardiometabolic outcomes 5 Type 2 Diabetes with Obesity Recommended first-line therapy: Modified-release Metformin + SGLT2 inhibitor Additional weight-focused therapies may be considered based on individual patient needs

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Table 3 Group differences in % change from previous timepoint including timepoints 1, 2, and 3 (main effects for the group)