Inclusion Criteria:  diagnosis of diabetes by OGTT age 40-74 years HbA1c 6.0-7.4% 1 hr OGTT glucose >155 mg/dl in each group  Exclusion Criteria:  CVD event during the previous year systemic glucocorticoids bariatric surgery stage III-IV congestive heart failure severe angina life expectancy <5 years BMI >40 kg/m2 pregnancy pancreatitis family or personal history of multiple endocrine neoplasia 2a an estimated glomerular filtration rate [eGFR] of ≤50 ml/min an alanine aminotransferase (ALT) level >3x the upper limit of the normal range dementia