Building Competency in Diabetes Education THE ESSENTIALS

TREATMENT MODALITIES: PHARMACOLOGICAL THERAPIES | 6-

Finally, there is also evidence for SGLT2i in adults with type 2 diabetes and CKD and an eGFR > 30mL/min/1.73m 2 at baseline to have reduced MACE outcomes. (listed with higher-level of evidence to lesser-level of evidence) • Canagliflozin 100mg (CREDENCE) • empagliflozin 10mg (EMPA-REG OUTCOME)

Of note, the results of DAPA-CKD were not available at the time of the Diabetes Canada Pharmacologic Glycemic Management of Type 2 Diabetes in Adults: 2020 update and are therefore not discussed.

3. IF A1C ABOVE INDIVIDUALIZED TARGET AND BLOOD GLUCOSE LOWERING REQUIRED

For many people living with type 2 diabetes, the ability to maintain glycemic control deteriorates over time as a result of a progressive decrease in beta cell function. The 2018 Guidelines advocate for more aggressive treatment to minimize the duration of hyperglycemia through early initiation of antihyperglycemic agents, including insulin, in order to achieve an individualized A1C target (usually ≤7% for people with type 1 diabetes and either ≤6.5% or ≤7.0% for people with type 2 diabetes) within three to six months (24).

ASSESSMENT PRIOR TO ADJUSTING/ADVANCING THERAPY : A. Ongoing assessment of A1C target

• Based on the presence of complications or comorbid conditions, functional, cognitive or self-care status, duration of diabetes and life expectancy, risk/ability to recognize and treat hypoglycemia and personal goals (22). • Table 1 provides considerations when determining an individual’s A1C target.