Building Competency in Diabetes Education THE ESSENTIALS

TREATMENT MODALITIES: PHARMACOLOGICAL THERAPIES | 6-8

Adjunctive therapy for glycemic control (16) There is growing interest in the use of non-insulin antihyperglycemic agents in type 1 diabetes to improve insulin sensitivity, provide additional BG lowering effects without increasing risk of hypoglycemia, and theoretically provide cardiovascular and renal benefits. Studies have focused on the use of metformin, SGLT2 inhibitors and GLP1 receptor agonists in people with type 1 diabetes. • Metformin: Reduces total daily insulin requirements, may cause weight loss, but does not improve A1C. A study by Lund et al. of 192 people with type 1 diabetes showed a decrease in insulin requirements by 5.7 u/day (p<0.001), and weight 1.74 kg, (p=0.03); however, when combined with four other smaller studies, the systematic review showed a trend towards a decrease in insulin requirements and weight (20). • SGLT2 inhibitors: Decrease mean glucose levels, weight and A1C. However, small trials have shown up to 6% of subjects experienced diabetic ketoacidosis (DKA). • GLP-1 RA Liraglutide: Reduces insulin requirements, and causes weight loss with inconsistent impact on A1C. In Canada, adjunctive therapy is not approved for use in people with type 1 diabetes. Further research is needed on the metabolic benefits of non-insulin antihyperglycemic agents in type 1 diabetes. Type 2 diabetes — NEWLY DIAGNOSED Therapy for all people with type 2 diabetes should focus on healthy behaviour interventions, including healthy food choices, weight reduction (5-10% if living with overweight/obesity) or weight maintenance, and the promotion of increased physical activity/exercise. Healthy behaviour interventions have been shown to improve BG and lipid profiles, as well as lower A1C levels by 1 to 2% (21) (see Chapter 5: Treatment Modalities: Lifestyle). The assessment and management of a person newly diagnosed with type 2 diabetes as outlined in figure 1 of the Diabetes Canada Quick Reference Guide is warranted. Of note, building from the 2018 Clinical Practice Guidelines, in the 2020 update, the assessment of the person with type 2 diabetes begins with consideration of glycemic control, cardiovascular and renal status, recent dietary patterns and weight change, rather than primarily looking at A1C.