Building Competency in Diabetes Education THE ESSENTIALS

TREATMENT MODALITIES: PHARMACOLOGICAL THERAPIES | 6-7

PHARMACOLOGICAL TREATMENT OPTIONS

The goals of pharmacological therapy for all people with diabetes are to: • Prevent or delay the onset and progression of complications. • Achieve optimal glycemic control based on individualized targets. • Minimize potential adverse effects related to treatment. • Maintain or improve the individual’s quality of life.

Type 1 diabetes Exogenous insulin therapy is indicated for all people with type 1 diabetes. A basal-bolus insulin regimen or continuous subcutaneous insulin infusion (CSII) is the regimen of choice for all adults with type 1 diabetes (16). Meta-analysis of randomized controlled trials continues to show a 0.2- 0.4% improvement in A1C with CSII therapy (17). Newer insulin analogues which mimic physiological endogenous insulin pharmacodynamics, as well as the various insulin delivery devices (insulin pens and insulin pumps with or without closed-loop systems) provide improved options for people living with type 1 diabetes.

For most people with Type 1 diabetes * : • The average total daily dose (TDD) requirement is 0.3 to 0.8 units/kg/day of insulin (up to <1.0 units/kg/day). • During the adolescent period , insulin requirements increase to 1.0 to 1.5 units/kg/day (18).

* People with type 1 diabetes and overweight/obesity may require higher total daily insulin doses.

Whole pancreas and islet-cell transplants are a treatment option for people with type 1 diabetes that can restore endogenous insulin production. Both procedures improve insulin independence and glycemic control, as well as reduce or eliminate hypoglycemia. This treatment option is limited to those individuals with persistent severe hypoglycemia and/or severe fluctuations in glycemic control. However, the small numbers of donor pancreases and specialized islet/pancreas transplant centres limits this treatment to only select individuals. Pancreas and islet-cell

transplant are associated with significant risks, side effects, require long-term immunosuppressant therapy and have limited long-term survival rates (19).