Building Competency in Diabetes Education THE ESSENTIALS

TREATMENT MODALITIES: PHARMACOLOGICAL THERAPIES | 6-22

○ While there are no randomized controlled trials to demonstrate intensive glycemic control decreases the risk of macrovascular complications and CVD in people with type 2 diabetes, the UKPDS 10-year post-trial follow-up revealed early intensive BG control resulted in risk reductions for myocardial infarction and reductions in death from any cause (11 ). This“legacyeffect”underscores the importance of early and aggressive treatment strategies to achieve glycemic targets (12). o Cardiovascular outcome trials have demonstrated cardiovascular and renal benefits that GLP-1 RA and SGLT2i agents can confer in high-risk population adults with type 2 diabetes, independent of A1C. • Treatment options: Healthy behaviour interventions remain essential for all people living with diabetes. However, for most people with type 2 diabetes, lifestyle interventions alone are not enough. o Pharmacotherapy can help alleviate the symptoms associated with hyperglycemia, reduce the risk of complications and assist people with diabetes in achieving both their glycemic targets and their personal health goals. • The action of antihyperglycemic agents: o Education should focus on the different classes of antihyperglycemic agents which target the underlying pathophysiology of type 2 diabetes, thereby lowering the risk of major adverse cardiovascular events (MACE), hospitalization for heart failure (HHF) and progression of nephropathy in high-risk populations and improving glycemic metrics. The benefits and managing potential adverse effects associated with each medication should be conveyed. • The benefits of blood glucose monitoring: Glucose monitoring, whether by capillary blood glucose checks or interstitial fluid glucose sensing, enables individuals to take an active role in their diabetes care, provides feedback on glucose levels, and can assist in evaluating a person’s glucose response to lifestyle choices and pharmacotherapy. (see Chapter 7: Monitoring Glycemic Management). Targeted and timely glucose monitoring can be considered for an engaged person with diabetes, who is able and willing to take action on glucose data, to support achievement of individualized glycemic goals and metrics. On the other hand, glucose monitoring in a disengaged person with diabetes can be poor cost-effective care and/or can lead to further burden on the person with diabetes.

Tables 1 to 9 provide a detailed overview of actions, considerations and cautions relating to the various antihyperglycemic agents. For more specific information, please refer to the latest edition of the Compendium of Pharmaceuticals and Specialties (38). Also, refer to the Diabetes Canada Guidelines website (guidelines.diabetes.ca).