Subcutaneously-administered GLP-1 RAs have demonstrated cardiovascular and renal risk reduction in individuals with type 2 diabetes at high ASCVD risk; they are recommended in the 2025 ADA Standards of Care as part of the comprehensive approach to cardiovascular and kidney risk reduction. Many individuals with type 2 diabetes are reluctant to initiate or refuse injectable therapy. Oral GLP-1 RA therapy has demonstrated robust reductions in A1C and in body weight; in addition, the cardiovascular safety of oral GLP-1 RA therapy has been established in individuals with T2D and high cardiovascular risk. Until recently, there has been an unmet need to determine the cardiovascular efficacy of this oral therapy in patients at high cardiovascular risk—for example, in those individuals with ASCVD, CKD, or both. Dr. Silvio Inzucchi and Dr. Darren McGuire will review trials with injectable GLP-1 RAs in individuals with T2D and high ASCVD risk, and discuss the recent clinical trial evidence in this population with oral GLP-1 RA therapy and the implications for patient management.