Building Competency in Diabetes Education THE ESSENTIALS

TREATMENT MODALITIES: PHARMACOLOGICAL THERAPIES | 6-21 EDUCATION OF THE PERSON WITH TYPE 2 DIABETES

Successful initiation of antihyperglycemic agents requires people with diabetes receive initial and ongoing education. While all education is tailored to meet the needs of the person with diabetes, the following concepts can be considered to be relayed to the person with diabetes to support the person in achieving their health outcomes: • The pathophysiology of type 2 diabetes: The core defects associated with type 2 diabetes are impaired insulin secretion due to beta-cell dysfunction and insulin resistance, resulting in increased hepatic glucose production and decreased glucose uptake in the peripheral tissues, primarily the muscle. Type 2 diabetes is also associated with a decreased incretin effect, increased glucose reabsorption in the kidney, and accelerated lipolysis of the adipocytes (fat tissue) (see Chapter 3: Pathophysiology) (34). • The rationale for treatment: There is extensive research demonstrating near-normal glycemic control is essential for preventing or delaying the development of microvascular complications of diabetes (3). Extensive research also indicates diabetes significantly accelerates the development and natural history of cardiovascular disease compared to individuals without diabetes. Healthy behaviour interventions and pharmacological approaches, independent of A1C, aimed at cardiovascular disease, progression of nephropathy and heart failure risk reduction can significantly reduce morbidity and mortality, and are an important cornerstone of the management of type 2 diabetes. o Reviewing the results of the UKPDS can help individuals understand type 2 diabetes is a ‘progressive disease requiring progressive treatment over time’. This may help to address any concerns or frustrations and alleviate any self-blame or guilt regarding inability to achieve and/or maintain glycemic targets. o Although the rate of decline in beta cell function varies between individuals with type 2 diabetes, the UKPDS provided a greater understanding of the pathophysiology of type 2 diabetes, showing, on average, participants had lost approximately 50% of beta cell function at the time of diagnosis (35). o More recent data suggests beta cell failure occurs early in the natural course of type 2 diabetes. People in the pre-diabetes stage (upper tertile of impaired glucose tolerance) have lost 80-85% of beta cell function (36). o In the UKPDS, beta cell function deteriorated over the course of the eight-year study (35). • A1C levels increased by 0.2 to 0.3% per year (37). • At three years post-diagnosis, 50% of participants required multiple pharmacological agents to achieve glycemic targets; this increased to 75% at nine years (37).