Data modified from Young et al.S3.2-12 CLINICAL STATEMENTS AND GUIDELINES Recommendations for Adults With Type 2 Diabetes Mellitus Referenced studies that support recommendations are summarized in Online Data Supplement 10. COR LOE Recommendations I A For all adults with T2DM, a tailored nutrition plan focusing on a heart-healthy dietary pattern is recommended to improve glycemic control, achieve weight loss if needed, and improve other ASCVD risk factors.S4.2-1,S4.2-2 I A Adults with T2DM should perform at least 150 minutes per week of moderate-intensity physical activity or 75 minutes of vigorous- intensity physical activity to improve glycemic control, achieve weight loss if needed, and improve other ASCVD risk factors.S4.2-3,S4.2-4 IIa B-R For adults with T2DM, it is reasonable to initiate metformin as first-line therapy along with lifestyle therapies at the time of diagnosis to improve glycemic control and reduce ASCVD risk.S4.2-5 S4.2-8 IIb B-R For adults with T2DM and additional ASCVD risk factors who require glucose-lowering therapy despite initial lifestyle modifications and metformin, it may be reasonable to initiate a sodium-glucose cotransporter 2 (SGLT-2) inhibitor or a glucagon-like peptide-1 receptor (GLP-1R) agonist to improve glycemic control and reduce CVD risk.S4.2-9 S4.2-14 4.3. Adults With High Blood Cholesterol Recommendations from the 2018 Cholesterol Clini- cal Practice GuidelinesS4.3-1 are included and adapted below. Table 4. Definitions and Examples of Different Intensities of Physical Activity Intensity METs Examples Sedentary behavior* 1 1.5 Sitting, reclining, or lying; watching television Light 1.6 2.9 Walking slowly, cooking, light housework Moderate 3.0 5.9 Brisk walking (2.4 4 mph), biking (5 9 mph), ballroom dancing, active yoga, recreational swimming Vigorous 6 Jogging/running, biking ( 10 mph), singles tennis, swimming laps *Sedentary behavior is defined as any waking behavior characterized by an energy expenditure 1.5 METs while in a sitting, reclining, or lying posture. 