An old fable, “Belling the Cat,” tells a story about a concerned group of mice that debate plans to nullify the threat of a menacing cat. One proposes placing a bell around its neck so that they are warned of its approach. The plan is met with applause, and the mice rejoice that their conundrum has been solved. This lasts until an old mouse asks, “That is all well, but who is to bell the cat?” All go on to make excuses why they cannot accomplish the task, and the cat continues to relentlessly hunt the mice. The moral of the fable is that it is one thing to say that something should be done but quite a different matter to actually do it.
There is a parallel between the fable and our current approach to managing cardiovascular risk in patients with type 2 diabetes mellitus (T2DM). For the first time ever, several classes of compounds initially developed for glucose lowering (oral sodium-glucose cotransporter type 2 inhibitors [SGLT2is] and injectable glucagon-like peptide-1 receptor agonists [GLP-1RAs]), have been shown to significantly improve cardiovascular outcomes, including reductions in cardiovascular mortality.1,2 These landmark developments have been celebrated by the cardiology community as major advancements in management. However, when the time comes to actually use these agents in clinical practice, it is all too common to hear excuses for why it is too cumbersome for cardiologist to prescribe these agents.