Building Competency in Diabetes Education THE ESSENTIALS

TREATMENT MODALITIES: PHARMACOLOGICAL THERAPIES | 6-61

Treatment Options

The 2018 Guidelines recommend : 1. Add AHA: Adding a DPP-4 inhibitor, GLP1- RA or SGLT2 inhibitor versus bolus insulin When compared to prandial insulin: • DPP-4 inhibitor: Improves glycemic control without weight gain. • SGLT2 inhibitor: Improves glycemic control, promotes weight loss, and lowers risk of hypoglycemia. • GLP1-RA: Results in greater A1C reduction, less hypoglycemia and weight loss (versus weight gain with prandial insulin). 2. Add GLP1-RA versus prandial insulin (if cost or adverse effects not an issue) • GLP1-RA associated with lower A1C, less hypoglycemia and weight loss versus weight gain with prandial insulin. • A systematic review and meta-analysis of 15 studies demonstrated that treatment with a GLP1-RA and basal insulin combination resulted in a statistically significant reduction in the following (153):